KR20120125519A - Rotatable cutting implement arrangements for ultrasonic surgical instruments - Google Patents

Abstract

In one general aspect, various embodiments relate to an ultrasonic surgical instrument that includes a handpiece housing rotatably supporting an ultrasonic transducer assembly that can be selectively rotated by a motor housed therein. Various types of blades and blades and sheath mounting configurations are disclosed that allow the blades to be selectively rotatable within the hollow outer sheath. The hollow outer sheath has at least one opening therein through which the blade tip can be exposed to the tissue. A vacuum may be applied to the cutting composition or through an external sheath to draw tissue through contact with a portion of the blade and through the opening (s) in the sheath.

Description

ROTATABLE CUTTING IMPLEMENT ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS

The present invention relates generally to an ultrasonic surgical system, and more particularly to an ultrasound system that allows a surgeon to perform tissue cutting and coagulation.

Over the years, a variety of different types of non-ultrasonically powered cutters and shaving devices have been developed for performing surgical procedures. Some of these devices use a rotary cutting mechanism while others use reciprocating cutting members. For example, razors are widely used for arthroscopic surgery. These devices generally consist of a power supply, a handpiece, and a single-use end effector. End actuators typically have inner and outer tubes. The inner tube will rotate relative to the outer tube and will cut tissue to its sharp edge. The inner tube can rotate or swing continuously. In addition, such a device may utilize a suction channel that moves through the interior of the inner tube. For example, US Pat. No. 4,970,354 to McGurk-Burleson et al. Discloses a non-ultrasound powered surgical cutting instrument that includes a rotary cutter for cutting material by shearing action. It uses an inner cutting member that is rotatable in the outer tube.

US Pat. No. 3,776,238 to Peyman et al. Discloses an ophthalmic instrument in which tissue is cut by a chopping action set by the sharp end of the inner tube moving against the inner surface of the end of the outer tube. do. US Pat. No. 5,226,910 to Kajiyama et al. Discloses another surgical cutting instrument having an inner member that moves relative to the outer member to cut tissue entering through an opening in the outer member.

U.S. Patent 4,922,902 to Wuchinich et al. Discloses a method and apparatus for endoscopic removal of tissue using an ultrasonic aspirator. The device uses an ultrasonic probe that breaks down the flexible tissue and aspirates it through the narrow orifice. US Pat. No. 4,634,420 to Spinosa et al. Discloses an apparatus and method for removing tissue from an animal and includes an elongated instrument having needles or probes that oscillate laterally at ultrasonic frequencies. Ultrasonic movement of the needle breaks down the tissue into fragments. Tissue pieces may be removed from the treatment area by suction through the conduit in the needle. Banko US Pat. No. 3,805,787 discloses another ultrasonic instrument with a shielded probe to narrow the beam of ultrasonic energy emitted from the tip of the probe. In one embodiment, the shield extends beyond the free end of the probe to prevent the probe from contacting tissue. Davis, US Pat. No. 5,213,569, discloses a phaco-emulsification needle that concentrates ultrasound energy. The concentrating surface can be inclined, curved or faceted. U.S. Patent No. 6,984,220 to Uchinich and US Patent Publication No. 2005/0177184 to Easley disclose an ultrasonic tissue incision system that provides combined longitudinal and torsional motion through the use of a longitudinal-torsion resonator. . US Patent Publication No. 2006/0030797 A1 to Zhou et al. Discloses an orthopedic device having an ultrasonic transducer and a drive motor for driving a horn. Between the drive motor and the transducer, an adapter is provided for supplying an ultrasonic energy signal to the transducer.

Although the use of ultrasonic powered surgical instruments offers some advantages over traditional mechanical powered saws, drills, and other instruments, it is possible that in bone and adjacent tissues due to frictional heating at the bone / tissue interface The increase in temperature may still be an important problem. Current arthroscopic tools include punches, reciprocating shavers, and radio frequency (RF) devices. Mechanical devices such as punches and razors create minimal tissue damage but can sometimes leave undesired rough cuts. RF devices can remove large amounts of soft tissue while creating smoother cuts, but they tend to produce more tissue damage than mechanical means. Therefore, it would be desirable to have an apparatus that can provide increased cutting precision while forming a smooth cutting surface without creating excessive tissue damage.

Arthroscopic surgery involves performing the surgery within the joint space. To perform the surgery, the joint is usually filled with pressurized saline for swelling and visualization. Ultrasonic instruments that can be used in such surgery must withstand fluid pressure without leakage. However, conventional ultrasonic instruments generally receive considerable force during use. Current seals on ultrasonic devices are generally not robust enough to withstand this environment without leakage.

It would be desirable to provide an ultrasound surgical instrument that overcomes some of the drawbacks of current instruments. The ultrasound surgical instrument described herein overcomes many of these drawbacks.

It would also be desirable to provide a more robust sealing device for ultrasound surgical instruments used for cutting and solidifying in an aqueous environment of arthroscopic surgery.

The above discussion is merely intended to illustrate some of the disadvantages presently present in the field of various embodiments of the invention and should not be taken as a negation of the scope of the claims.

In connection with one general aspect, there is provided an ultrasound surgical instrument that may include a housing having an ultrasonic transducer assembly rotatably supported therein that is in communication with a source of an ultrasound electrical signal. The motor may be supported in the housing. The motor communicates with a source of motor drive signals and is coupled to the ultrasonic transducer assembly to apply rotational motion to the ultrasonic transducer assembly. The horn can be coupled to the ultrasonic transducer assembly. A hollow outer sheath can be coupled to the housing and can have a distal tip portion on which at least one cutting edge is formed. A blade may be coupled to the horn and have a tissue cutting distal end. The blade may be rotatably supported in the outer sheath such that the tissue cutting distal end is deflected in cut engagement with the at least one cutting edge on the distal tip portion of the hollow outer sheath.

In connection with another general aspect, an ultrasound surgical instrument is provided that may include a housing having an ultrasonic transducer assembly rotatably supported therein that is in communication with a source of an ultrasound electrical signal. The motor can be supported in the housing and can communicate with a source of motor drive signals. The motor may be coupled to the ultrasonic transducer assembly to apply rotational motion to the ultrasonic transducer assembly. The horn can be coupled to the ultrasonic transducer assembly. The hollow outer sheath can be coupled to the housing and can have a distal tip portion defining the tip cavity therein. The blade can be coupled to the horn and have a tissue cutting distal end. The blade may be rotatably supported in the outer sheath and may have a tissue cutting distal end portion that is rotatably supported in the tip cavity. Friction reducing material may be supported in the tip cavity.

In connection with another general aspect, an ultrasound surgical instrument is provided that may include a housing having an ultrasonic transducer assembly rotatably supported therein that is in communication with a source of an ultrasound electrical signal. A motor in communication with the source of motor drive signals may be supported in the housing. The motor may be coupled to the ultrasonic transducer assembly to apply rotational motion to the ultrasonic transducer assembly. The horn can be coupled to the ultrasonic transducer assembly. The hollow outer sheath can be coupled to the housing and can have a distal tip portion that defines the tip cavity. The blade can be coupled to the horn and can be rotatably supported in the outer sheath. The blade may have a tissue cutting distal end portion that is rotatably supported within the tip cavity. Low friction material may be provided on at least a portion of the tissue cutting distal end of the blade.

Features of the various non-limiting embodiments are particularly described in the appended claims. However, various non-limiting embodiments may be best understood by reference to the following description taken in connection with the accompanying drawings, in conjunction with their further objects and advantages, both with respect to the method and organization of the operation.
≪ 1 >
1 is a schematic representation of a non-limiting embodiment of a surgical control system.
Figure 1a
1A is a perspective view of a non-limiting embodiment of a control system enclosure.
Figure 1b
1B is a perspective view of another non-limiting embodiment of a control system enclosure configuration.
2,
2 is a cross-sectional view of a non-limiting embodiment of a handpiece.
3,
3 is a partial cross-sectional view of an ultrasonic surgical handpiece that may be used with various non-limiting embodiments.
<Fig. 4>
4 is a cross-sectional view of a portion of a non-limiting nosepiece embodiment.
5,
5 is a partially exploded view of a non-limiting nosepiece embodiment.
6,
6 is a partial cross-sectional view of a non-limiting embodiment of a surgical instrument handpiece.
7,
7 is a perspective view of a non-limiting surgical instrument handpiece embodiment of FIG.
8,
8 is a partial cross-sectional view of another non-limiting surgical instrument handpiece embodiment.
9,
9 is a partial cross-sectional view of another non-limiting surgical instrument handpiece embodiment.
<Fig. 10>
10 is a perspective view of the surgical instrument handpiece embodiment shown in FIG. 9.
<Figure 11>
11 is a partially exploded view of a non-limiting coupling assembly embodiment for coupling a motor to a transducer assembly.
<Figure 12>
12 is a side view of a thin plate member and drive shaft configuration of a non-limiting coupling assembly embodiment.
Figure 13
13 is an end view of the non-limiting sheet member embodiment of FIG.
<Figure 14>
14 is a side view of a non-limiting sheet member and drive shaft configuration of another non-limiting coupling assembly embodiment.
Figure 15
15 is an end view of the non-limiting sheet member embodiment of FIG.
<Figure 16>
16 is a partial cross-sectional view of another non-limiting surgical instrument handpiece embodiment.
<Figure 17>
17 is a partial perspective view of a non-limiting outer sheath and blade embodiment.
18,
FIG. 18 is a partial perspective view of the non-limiting blade embodiment shown in FIG. 17. FIG.
19,
19 is a partial bottom perspective view of the blades of FIGS. 17 and 18.
20,
20 is a side view of a portion of another non-limiting blade embodiment.
21,
21 is a side view of a portion of another non-limiting blade embodiment.
22,
22 is a partial perspective view of the distal end of another non-limiting outer sheath and blade configuration.
Figure 23
23 is a partial perspective view of the distal end of another non-limiting outer sheath and blade configuration.
Figure 23a
FIG. 23A is a side view of a portion of the non-limiting outer sheath embodiment shown in FIG. 23. FIG.
<Figure 24>
24 is a side view of a portion of another non-limiting blade embodiment.
25,
25 is a side view of a portion of another non-limiting blade embodiment.
26,
FIG. 26 is a partial perspective view of the non-limiting blade embodiment of FIG. 25 within the distal end of another non-limiting outer sheath embodiment.
<Fig. 27>
27 is a side view of a portion of another non-limiting blade embodiment.
28,
28 is a partial perspective view of the non-limiting blade embodiment of FIG. 27 within the distal end of another non-limiting outer sheath embodiment.
29,
29 is a partial cross-sectional end view of the non-limiting blade and outer sheath embodiment of FIG. 28.
30,
30 is a side view of a portion of another non-limiting blade embodiment.
31,
FIG. 31 is a partial perspective view of the non-limiting blade embodiment of FIG. 30 within the distal end of another non-limiting outer sheath embodiment.
<Figure 32a>
FIG. 32A illustrates a first rotational position of the non-limiting blade embodiment of FIGS. 30 and 31 within the outer sheath embodiment of FIG. 31.
Figure 32b
FIG. 32B illustrates a second rotational position of the non-limiting blade embodiment of FIGS. 30 and 31 within the outer sheath embodiment of FIG. 31.
<FIG. 32C>
FIG. 32C illustrates a third rotational position of the blade embodiment of FIGS. 30 and 31 within the outer sheath embodiment of FIG. 31.
<FIG. 32D>
FIG. 32D illustrates a fourth rotational position of the blade embodiment of FIGS. 30 and 31 within the outer sheath embodiment of FIG. 31.
<Figure 33>
33 is a perspective view of a portion of another non-limiting blade embodiment.
<Figure 34>
FIG. 34 is a partial perspective view of the blade embodiment of FIG. 33 within a non-limiting outer sheath embodiment.
<Figure 34a>
34A is a partial perspective view of another non-limiting blade and outer sheath embodiment.
<Figure 35>
35 is a perspective view of a portion of another non-limiting blade embodiment.
<Figure 36>
36 is a partial cross-sectional view of another non-limiting ultrasound surgical instrument embodiment.
<Figure 36a>
36A is a partial cross-sectional view of a nosepiece portion of another non-limiting surgical instrument embodiment of the present invention.
<Figure 37>
FIG. 37 is a partial perspective view of the distal end of the non-limiting outer sheath and blade configuration of FIG. 36. FIG.
<Figure 38>
FIG. 38 is a cross-sectional view of the distal portion of the outer sheath and blade embodiment shown in FIG. 37, cutting tissue. FIG.
<Figure 39>
FIG. 39 illustrates the use of the surgical instrument embodiment of FIG. 36 in connection with performing discectomy.
<Figure 40>
FIG. 40 illustrates further use of the surgical instrument embodiment of FIG. 36 in connection with performing an intervertebral discectomy.
<Figure 41>
Figure 41 is a side view of the surgical instrument embodiment of Figure 36 with an optionally retractable safety sheath mounted thereon.
<Figure 42>
FIG. 42 is a partial perspective view of the retractable safety sheath embodiment illustrated in FIG. 41, beginning to retract from the closed position.
<Figure 43>
43 is another partial perspective view of the retractable safety sheath embodiment illustrated in FIGS. 41 and 42 with the safety sheath retracted to the open position.
<Figure 44>
44 is another partial perspective view of the retractable safety sheath embodiment illustrated in FIGS. 41-43 with the safety sheath retracted to an open position.
<Figure 45>
45 is a side view of a portion of the outer sheath and safety sheath embodiment illustrated in FIGS. 41-44 with the safety sheath shown in cross section in the open position;
<Figure 46>
46 is a perspective view of a portion of another non-limiting blade embodiment.
<Figure 47>
47 is a side view of a portion of another hollow outer sheath and blade configuration in another non-limiting embodiment.
<Figure 48>
48 is a cross-sectional view of another non-limiting blade embodiment.
<Figure 49>
49 is a sectional view of another non-limiting blade embodiment.
<Figure 50>
50 is a cross-sectional view of another non-limiting blade embodiment.
<Figure 51>
51 is a cross-sectional view of another non-limiting blade embodiment.
<Figure 52>
52 is a partial cross-sectional view of another non-limiting outer sheath and blade embodiment.
Fig. 53
FIG. 53 is another partial cross-sectional view of the outer sheath and blade embodiment of FIG. 52 interacting with body tissue. FIG.
<Figure 54>
54 is an end cross-sectional view of the outer sheath and blade configuration shown in FIGS. 52 and 53, interacting with body tissue.
<Figure 55>
55 is a partial perspective view of another non-limiting outer sheath embodiment.
Fig. 56
56 is a partial perspective view of another non-limiting outer sheath embodiment.
<Figure 57>
FIG. 57 is a partial cross-sectional view of the outer sheath embodiment of FIG. 56 supporting another non-limiting blade embodiment.
<Figure 58>
58 is a partial perspective view of another non-limiting outer sheath embodiment.
<Figure 59>
59 is a cross-sectional view of another non-limiting outer sheath and blade embodiment.
<Figure 60>
60 illustrates the angle between cutting edges formed on a non-limiting outer sheath embodiment.
<Figure 61>
61 is a perspective view of another non-limiting outer sheath embodiment.
<Figure 62>
FIG. 62 is a cross sectional view of the outer sheath and blade embodiment of FIG. 61; FIG.
<Figure 63>
63 is a perspective view of another non-limiting outer sheath embodiment.
<Figure 64>
64 is a cross sectional view of the outer sheath and blade embodiments of FIG. 63;
<Figure 65>
65 is a perspective view of another non-limiting outer sheath embodiment.
<Figure 66>
FIG. 66 is a cross sectional view of the outer sheath and blade embodiment of FIG. 65; FIG.
<Figure 67>
67 is a cross-sectional end view of another non-limiting outer sheath and blade configuration.
<Figure 68>
FIG. 68 is a partial side cross-sectional view of the outer sheath and blade configuration of FIG. 67; FIG.
<Figure 69>
FIG. 69 is a partial side view of the distal end portion of the outer sheath and blade configurations of FIGS. 67 and 68.
<Figure 70>
70 is a side view of a non-limiting handpiece housing embodiment attached to the outer sheath and blade configurations of FIGS. 67-69.
<Figure 71>
FIG. 71 illustrates a method of using the surgical instrument embodiment of FIG. 70.
<Figure 72>
FIG. 72 illustrates another method of using the surgical instrument embodiment of FIG. 70.
Figure 73
FIG. 73 illustrates another method of using the surgical instrument embodiment of FIG. 70.
<Figure 74>
74 is a partial side cross-sectional view of another non-limiting surgical instrument embodiment.
<FIG. 75>
FIG. 75 is a perspective view of a portion of an outer sheath and blade configuration used in the surgical instrument embodiment shown in FIG. 74.
<Figure 76>
FIG. 76 is an end view of the outer sheath and blade configuration of FIG. 75; FIG.
<Figure 77>
FIG. 77 is a cross sectional end view of the sheath and blade configuration of FIGS. 75 and 76; FIG.
Figure 78
78 is a side view of another non-limiting ultrasound surgical instrument embodiment.
<Figure 79>
79 is a partial cross-sectional view of a non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
<Figure 80>
80 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
Fig. 81
81 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
<Figure 82>
82 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
<Figure 83>
FIG. 83 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment prior to crimping into a predetermined position.
<Figure 84>
84 is a partial cross-sectional view of the seal embodiment of FIG. 83 after crimped to a desired location.
Fig. 85
85 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the two-piece hollow sheath of the ultrasonic tool embodiment.
<Figure 86>
86 is a partial cross-sectional exploded view of another non-limiting seal embodiment between the waveguide portion and another two-piece hollow sheath of the ultrasonic tool embodiment;
<Figure 87>
FIG. 87 is a partial perspective view of a portion of the two piece hollow sheath embodiment of FIG. 86.
Figure 88
88 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
<Figure 89>
89 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
Fig. 90
90 is a partial cross-sectional view of another non-limiting seal embodiment between the waveguide portion and the hollow sheath of the ultrasonic tool embodiment.
Figure 91A
FIG. 91A shows the initial position of two cut edge embodiments, preparing for cutting tough tissue. FIG.
Figure 91b
FIG. 91B is a view of the cut edge and second position of the tissue of FIG. 91A. FIG.
Figure 91c
FIG. 91C is a view of the cut edge and the third position of the tissue of FIGS. 91A and 91B.
Figure 91d
FIG. 91D is a view of the cut edge and fourth position of the tissue of FIGS. 91A-91C. FIG.
<Figure 92>
92 is a perspective view of a portion of a non-limiting cutting blade and bushing embodiment.
<Figure 92A>
FIG. 92A is a partial cross-sectional view of a portion of the blade and bushing embodiment of FIG. 92 installed in an internal sheath of a non-limiting surgical instrument embodiment.
<Figure 93>
93 is a cross-sectional view of a portion of the blade and bushing embodiment of FIG. 92 in a non-limiting surgical instrument embodiment.
<Figure 94>
94 is a perspective view of a portion of another non-limiting cutting blade and bushing embodiment.
<Figure 95>
FIG. 95 is a cross-sectional view of a portion of the blade and bushing embodiment of FIG. 94 in a non-limiting surgical instrument embodiment.
<Figure 96>
96 is a partial perspective view of a portion of a non-limiting blade and outer sheath embodiment.
<Figure 97>
FIG. 97 is a cross sectional view of the blade and outer sheath configuration of FIG. 96; FIG.
<Figure 98>
FIG. 98 is a partial rear perspective view of a portion of the outer sheath and blade configuration of FIG. 97.
<Figure 99>
99 is a partial rear perspective view of a portion of another non-limiting outer sheath and blade embodiment.
<Figure 100>
100 is a partial perspective view of another non-limiting outer sheath embodiment.
Fig. 101
FIG. 101 is a cross-sectional end view of the outer sheath embodiment of FIG. 100 supporting a cutting blade embodiment therein;
<Figure 102>
102 is a perspective view of a portion of another non-limiting blade embodiment.

The owner of this application also owns the following U.S. patent applications, each of which is filed on the same day as this application and each of which is incorporated by reference in its entirety:

US Patent Application No. _________ (Agent Control Number END6688USNP / 090341) entitled “ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATING CUTTING IMPLEMENT”;

US Patent Application No. _________ (Agent Control Number END6689USNP) entitled "METHODS OF USING ULTRASONICALLY POWERED SURGICAL INSTRUMENTS WITH ROTATABLE CUTTING IMPLEMENTS". / 090342);

US Patent Application No. _________ (Agent Control Number END6690USNP / 090343) entitled "SEAL ARRANGEMENTS FOR ULTRASONICALLY POWERED SURGICAL INSTRUMENTS";

U.S. Patent Application _________ (Attorney Management No. END6691USNP / 090344) entitled "ULTRASONIC SURGICAL INSTRUMENTS WITH ROTATABLE BLADE AND HOLLOW SHEATH ARRANGEMENTS." ;

U.S. Patent Application No. _________ (Attorney Management Number END6693USNP) entitled "ULTRASONIC SURGICAL INSTRUMENTS WITH PARTIALLY ROTATING BLADE AND FIXED PAD ARRANGEMENT" / 090346);

US Patent Application No. ____________ (Agent Control Number END6694USNP / 090347) entitled “DUAL PURPOSE SURGICAL INSTRUMENT FOR CUTTING AND COAGULATING TISSUE”;

US Patent Application No. _________ (Attorney Management No. END6695USNP / 090348) entitled "OUTER SHEATH AND BLADE ARRANGEMENTS FOR ULTRASONIC SURGICAL INSTRUMENTS";

US Patent Application No. _________ (Agent Control Number END6687USNP / 090349), entitled "ULTRASONIC SURGICAL INSTRUMENTS WITH MOVING CUTTING IMPLEMENT"; And

U.S. Patent Application No. _________ (Agent Control Number END6686USNP / 090367) entitled "ULTRASONIC SURGICAL INSTRUMENT WITH COMB-LIKE TISSUE TRIMMING DEVICE".

Various embodiments relate to apparatus, systems, and methods for the treatment of tissue. Numerous specific details are set forth in order to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. However, those skilled in the art will understand that embodiments may be practiced without such specific details. In other instances, well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. Those skilled in the art will understand that the embodiments described and illustrated herein are non-limiting examples, and thus the specific structural and functional details disclosed herein may be representative and range of embodiments defined only by the appended claims. It can be appreciated that this is not necessarily a limitation.

Reference throughout this specification to “various embodiments”, “some embodiments”, “one embodiment”, or “one embodiment”, etc., is directed to at least a particular feature, structure, or characteristic described in connection with the embodiment. It is meant to be included in one embodiment. Thus, the appearances of the phrases “in various embodiments”, “in some embodiments”, “in one embodiment”, or “in one embodiment” in various places throughout the specification are necessarily all the same embodiment. It does not refer to. In addition, certain features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, a particular feature, structure, or characteristic illustrated or described in connection with one embodiment can be combined in whole or in part with the features, structure, or characteristic of one or more other embodiments without limitation.

Various embodiments relate to ultrasound surgical systems and instruments configured to achieve tissue incision, cutting, and / or coagulation during surgical procedures, as well as cutting tools and sealing features utilized thereby. In one embodiment, the ultrasound surgical instrument device is configured for use in open surgical procedures, but is applied to other types of surgery such as laparoscopic, endoscope, and robot-assisted procedures. The versatile use is facilitated by the selective use of ultrasonic energy and the selective rotation of the cutting / coagulation tool.

It will be appreciated that the terms "proximal" and "distal" are used herein in connection with a clinician holding a handpiece assembly. Thus, the end actuator is distal with respect to the more proximal handpiece assembly. Also, for convenience and clarity, it will be appreciated that spatial terms such as "top" and "bottom" are also used herein in connection with a clinician gripping the handpiece assembly. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

Surgical System

1 illustrates in schematic form one non-limiting embodiment of a surgical system 10. The surgical system 10 may include an ultrasonic generator 12, and an ultrasonic surgical instrument assembly 100, which may include a “self-contained” ultrasonic instrument 110. As discussed in further detail below, the ultrasonic generator 12 is connected to a slip ring assembly 150 located within the housing portion 102 of the surgical instrument assembly 100 by means of a cable 14. By means of the ultrasonic transducer assembly 114 of the self-contained ultrasonic instrument 110. In one embodiment, the system 10 includes a motor control system 20 that includes a power supply 22 coupled to supply, for example, 24 VDC to the control module 24 by a cable 23. Additionally included. Motor control module 24 may include a control module manufactured under the model number NI cRIO-9073 by National Instruments, Austin, Texas. However, other motor control modules can be used. The power supply 22 may include a power supply manufactured by National Instruments. However, other power supplies can be used successfully. The power supply 22 can also be coupled to the motor drive 26 by the cable 25 to supply 24 VDC to it. The motor driver 26 may include a motor driver manufactured by National Instruments. The control module 24 may also be coupled to the motor drive 26 by means of a cable 27 to power it. A conventional foot pedal 30 or other control switch device may be attached to the control module 24 by a cable 31. As discussed in further detail below, ultrasonic surgical instrument 100 may include a motor 190 having an encoder 194 associated therewith. Motor 190 may include a motor manufactured by Model Number CTP12ELF10MAA00 by National Instruments. Encoder 194 is a U.S.-based company in Vancouver, Washington. It may include an encoder manufactured by model number E2-500-197-I-D-D-B by U.S. Digital. However, other motors and encoders can be used. Encoder 194 may be coupled to motor control module 24 by encoder cable 32, and motor 190 may be coupled to motor drive 26 by cable 33. The surgical system 10 may also include a computer 40 capable of communicating by the motor control module 24 and the Ethernet cable 42.

As can also be seen in FIG. 1, in various embodiments, the motor control system 20 is housed in an enclosure 21. To facilitate the ease of portability of the system, various components may be attached to the motor control system 20 by removable cable connectors. For example, the foot pedal switch 30 may be attached to the detachable cable connector 37 by the cable 35 to facilitate quick attachment of the foot pedal to the control system 20. A / C power may be supplied to the power supply 22 by a conventional plug / cable 50 attached to a detachable cable connector 54 attached to the cable 52. Computer 40 may have a cable 60 attached to a detachable cable connector 62 coupled to cable 42. The encoder 194 may have an encoder cable 70 attached to a removable connector 72. Again, the motor 190 may have a cable 74 attached to the detachable connector 72. The detachable connector 72 may be attached to the control module 24 by the cable 32, and the connector 72 may be attached to the motor drive 26 by the cable 33. Thus, the cable connector 72 serves to couple the encoder 194 to the control module 24 and the motor 190 to the motor driver 26. Cables 70 and 74 may be received in common sheath 76.

In alternative embodiments, the ultrasonic generator 12 and the control system 20 may be housed in the same enclosure 105. See FIG. 1A. In another embodiment, the ultrasonic generator 12 may be in electrical communication with the motor control system 20 by a jumper cable 107. Such a configuration may share a data link as well as a common means for powering (code 50). See FIG. 1B.

In various embodiments, the ultrasonic generator 12 may include an ultrasonic generator module 13 and a signal generator module 15. Please refer to Fig. The ultrasonic generator module 13 and / or the signal generator module 15 may each be integral with the ultrasonic generator 12 or may be provided as a separate circuit module electrically coupled to the ultrasonic generator 12 (such as Shown as phantom lines to illustrate the option). In one embodiment, the signal generator module 15 may be integrally formed with the ultrasonic generator module 13. The ultrasonic generator 12 may include an input device 17 located on the front panel of the generator 12 console. Input device 17 may include any suitable device for generating a signal suitable for programming the operation of generator 12 in a known manner. With continued reference to FIG. 1, cable 14 includes a plurality of electrical conductors for applying electrical energy to the positive and negative electrodes of ultrasonic transducer assembly 114 as discussed in further detail below. It may include.

Various forms of ultrasonic generators, ultrasonic generator modules and signal generator modules are known. For example, such a device is filed on July 15, 2007, which is incorporated herein by reference in its entirety and entitled “Rotating Transducer Mount For Ultrasonic Surgical Instruments”. Is disclosed in U.S. Patent Application 12 / 503,770, owned by Ph. All other such devices are disclosed in one or more of the following U.S. patents, which are incorporated herein by reference: U.S. Pat. Up of an Ultrasonic System Under Zero Load Conditions)); US Patent No. 6,537,291 (Method for Detecting a Loose Blade in a Handle Connected to an Ultrasonic Surgical System); US Patent No. 6,626,926 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup); US Patent No. 6,633,234 (Method for Detecting Blade Breakage Using Rate and / or Impedance Information); US Pat. No. 6,662,127 (Method for Detecting Presence of a Blade in an Ultrasonic System); US Patent No. 6,678,621 (Output Displacement Control Using Phase Margin in an Ultrasonic Surgical Handle); US Patent No. 6,679,899 (Method for Detecting Transverse Vibrations in an Ultrasonic Handle); US Patent No. 6,908,472 (Apparatus and Method for Altering Generator Functions in an Ultrasonic Surgical System); US Patent No. 6,977,495 (Detection Circuitry for Surgical Handpiece System); US Patent No. 7,077,853 (Method for Calculating Transducer Capacitance to Determine Transducer Temperature); US Patent No. 7,179,271 (Method for Driving an Ultrasonic System to Improve Acquisition of Blade Resonance Frequency at Startup); And US Pat. No. 7,273,483 (Apparatus and Method for Alerting Generator Function in an Ultrasonic Surgical System).

Surgical instrument

As can be seen in FIG. 2, the ultrasonic surgical instrument handpiece 100 includes a housing that houses a motor 190, an encoder 194, a slip ring assembly 150, and a self-contained ultrasonic surgical instrument 110. 102). The housing 102 may be provided in two or more parts attached together by fasteners, such as screws, snap features, and the like, and may be made, for example, from polycarbonate material. Motor 190 may comprise a stepper motor, for example manufactured by Model Instruments CTP12ELF10MAA00 by National Instruments. However, other motors may be used to achieve the “gross” rotational movement of the self-contained ultrasound surgical instrument 110 relative to the housing 102, for example on the order of 1 to 6000 rpm. Encoder 194 converts the mechanical rotation of motor shaft 192 into electrical pulses that provide speed and other motor control information to control module 24.

The self-contained ultrasound surgical instrument 110 may include a surgical instrument manufactured and sold under model number HP054 by Ethicon Endo-Surgery. However, other ultrasonic instruments may be used successfully. As used herein, it will be understood that the term "self-contained" means that an ultrasound surgical instrument can be effectively used independently and independently as an ultrasound surgical instrument, apart from that used with the surgical instrument 100. will be. As illustrated in more detail in FIG. 3, the ultrasound surgical instrument 110 converts electrical energy into mechanical energy that causes longitudinal vibrational movement of the ends of the transducer assembly 114. And a housing 112 that supports 114. The ultrasonic transducer assembly 114 may comprise a stack of ceramic piezoelectric elements, where a motion null point is located at a point along the stack. The ultrasonic transducer assembly 114 may be mounted between two cylinders 116, 118. In addition, a cylinder 120 may be attached to the cylinder 118, which is then mounted to the housing at another knurled null point 122. Horn 124 may also be attached to the null point on one side and to coupler 126 on the other side. Blade 200 may be secured to coupler 126. As a result, the blade 200 will vibrate longitudinally at the ultrasonic frequency rate with the ultrasonic transducer assembly 114. The ends of the ultrasonic transducer assembly 114 perform maximum motion with the portion of the stack forming a motionless node when the ultrasonic transducer assembly 114 is driven with maximum current at the resonant frequency of the transducer. To achieve. However, the current that provides the maximum motion will vary from instrument to instrument and is the value stored in the instrument's non-volatile memory for the system to use.

The components of the ultrasonic instrument 110 may be designed such that the combination oscillates at the same resonant frequency. In particular, the elements may be adjusted such that the resulting length of each such element is one-half wavelength or multiples thereof. The longitudinal back and forth motion is amplified as the diameter closer to the blade 200 of the acoustic mounting horn 124 decreases. Thus, the blade / coupler as well as the horn 124 can be set to shapes and dimensions that amplify the blade movement and provide ultrasonic vibrations that resonate with the remainder of the sonic system, which is a sound wave mounted horn (near the blade 200). Create a maximum back and forth motion of the end of 124. The motion of 20-25 micrometers in the ultrasonic transducer assembly 114 may be amplified by the horn 124 with blade travel of about 40-100 micrometers.

When power is applied to the ultrasonic instrument 110 by operation of the foot pedal 30 or other switch device, the control system 20 may cause the blade 200 to vibrate longitudinally at approximately 55.5 kHz, for example. And the longitudinal movement amount will change in proportion to the amount of driving power (current) applied, as selected to be adjustable by the user. When a relatively high cutting power is applied, the blade 200 can be designed to move longitudinally in the range of about 40 to 100 micrometers in the ultrasonic vibration rate. Such ultrasonic vibration of the blade 200 will generate heat as the blade contacts the tissue, i.e. acceleration of the blade 200 through the tissue causes heat in the very narrow and localized region of the mechanical energy of the moving blade 200 to move. Convert to energy. This localized heat produces a narrow zone of coagulation, which will reduce or eliminate bleeding in small vessels such as those less than 1 millimeter in diameter. The degree of hemostasis as well as the cutting efficiency of the blade 200 will vary depending on the level of driving power applied, the force or cutting speed exerted on the blade by the surgeon, the nature of the tissue type and the vascularity of the tissue.

As can be seen in FIG. 2, the ultrasonic instrument 110 is supported in the housing 102 by a tailpiece drive adapter 130 and a distal handpiece adapter 134. The tailpiece drive adapter 130 is rotatably supported in the housing 102 by the proximal bearing 132 and is rotatably coupled to the output shaft 192 of the motor 190. See FIG. Tailpiece drive adapter 130 may be pressed onto housing 112 of ultrasound instrument 110 or may be attached to housing 112 by, for example, a setscrew or adhesive. Distal handpiece adapter 134 may be pressed onto distal end 113 of handpiece housing 112 or otherwise attached to it by a set screw or adhesive. Distal handpiece adapter 134 is rotatably supported in housing 102 by distal bearing 136 mounted in housing 102.

When power is applied to the motor 190, the motor 190 applies a “total rotational motion” to the handpiece 110 to cause the ultrasound surgical instrument 110 and the blade 200 to rotate about the central axis AA. Is authorized. As used herein, the term "total rotational motion" should be distinguished from the term "torsional ultrasonic motion" that can be achieved when using non-homogeneously formed ultrasonic blades. The term "total rotational motion" includes rotational motion instead of being generated solely by the operation of the ultrasonic transducer assembly 114.

Slip ring assembly 150 may be used to provide power from ultrasonic generator 12 to ultrasonic instrument 110. As can be seen in FIG. 2, the conductors 151, 152 are coupled to the ultrasonic transducer assembly 114 and extend through the hollow stem portion 132 of the tailpiece drive adapter 130. . The hollow stem portion 132 is attached to the drive shaft 192 of the motor 190 and freely rotates in the slip ring assembly 150. A first internal contact 154 is attached to the hollow stem portion 132 so as to travel with rotation about axis A-A together. The first inner contact 154 is positioned in rotational contact with the fixed outer contact 156 within the slip ring assembly 150. The contacts 154 and 156 may be provided in the form of rings arranged concentrically. Conductors 157 and 158 are coupled to fixed external contacts 156 and form generator cable 14. Conductors 191, 193 are attached to the motor and form motor cable 74, and conductors 195, 197 are attached to encoder 194 and form encoder cable 70. Rotation of motor shaft 192 causes rotation about axis A-A of tailpiece drive adapter 130 and ultrasonic instrument 110 attached thereto. Rotation of the motor drive shaft 192 also causes rotation of the internal contact 154. The ultrasonic signal from the ultrasonic generator 12 is transmitted to the internal contact 154 by a contact or "electrical communication" between the internal contact 154 and the external contact 156. These signals are transmitted to the ultrasonic transducer assembly 114 by the conductors 151, 152. In another alternative embodiment, the slip ring assembly may utilize the use of conventional pogo pins that engage concentric ring contacts. Other slip ring devices may also be used.

Various embodiments also include a distal nosepiece 160 that can be removably attached to distal end 103 of housing 102 by fastener 161. See FIG. 5. One or more shim members 162 may be positioned between distal end 103 and nosepiece 160 to facilitate coaxial attachment between housing 102 and nosepiece 160. The nosepiece 160 may be made from, for example, stainless steel or polycarbonate. In various embodiments, the distal end 202 of the blade 200 extends through the hollow coupler segment 210 journaled in the inner sheath seal 212. Inner sheath seal 212 may include, for example, polytetrafluoroethylene (“PTFE”), establishing a substantially liquid tight and / or airtight seal between coupler segment 210 and nosepiece 160. Can play a role. In addition, in the embodiment of FIG. 4, the inner sheath 220 may be attached to the hollow coupler segment 210, for example by welding, or the hollow coupler segment 210 is integral of the inner sheath 220. It can include a part. In one embodiment, the blade pin / torquing member 216 is through the blade member 200 and the hollow coupler segment 210 to facilitate movement of the inner sheath 220 with the blade member 200. It can extend laterally. One or more vented silicone bushings 214 may be journaled around the blades 200 to sonically shield the blades 200 from the inner sheath 220. Blade member 200 may have a proximal end 201 threaded therein and configured to removably engage a threaded portion of coupler 126. To facilitate tightening of the blade 200 to the coupler 126, a tightening hole 108 (FIG. 2) is provided through the housing 102 to provide an ultrasonic surgical instrument 110 and a coupler attached thereto ( A tool (eg, Allen wrench) can be inserted through the hole 131 in the tailpiece drive adapter 130 to prevent rotation of the 126. Once the blade 200 is screwed into the coupler 126, the user removes an allen wrench or other tool from the holes 108, 131 and inserts a threaded plug (not shown) into the hole 108 through the hole. Fluid / dust can be prevented from entering the housing 102.

Further, in various embodiments, the outer sheath 230 may be coaxially aligned with the inner sheath 220 and the blade member 200, for example welding, brazing, overmolding or interference fit. The fit may be attached to the distal end 163 of the nosepiece 160. As can be seen in FIG. 4, a suction port 240 can be attached to the nosepiece 160 to communicate with the hollow outer sheath 230. The flexible tube 242 can be attached to the suction port 240 and in communication with a collection receptacle 243 which is coupled to a vacuum source, shown generally at 244. Thus, the outer sheath 230 forms a suction path extending around the inner sheath 220, starting at the distal tip of the outer sheath 230 and leading outward through the suction port 240. Those skilled in the art will appreciate that alternative inhalation routes are also possible. Also, in alternative embodiments, the inner sheath 220 is omitted.

Various embodiments of the surgical system 10 provide the ability to selectively apply ultrasonic axial motion to the blades 200 and overall rotational motion to the blades 200 as well. If necessary, the clinician can operate the ultrasonic transducer assembly 114 without simply operating the motor 190. In such a case, the instrument 100 may simply be used in an ultrasonic mode as an ultrasonic instrument. The frequency range for the longitudinal ultrasonic motion can be on the order of 30 to 80 kHz, for example. Similarly, the clinician may wish to operate the motor 190 without operating the ultrasonic transducer assembly 114. Thus, the overall rotational motion will be applied to the blade 200 in the rotational mode, without the application of longitudinal ultrasonic motion thereto. The overall rotational speed may be on the order of 1 to 6000 rpm, for example. In other applications, the clinician may want to use the instrument 100 in ultrasound and rotation mode, where the blade 200 will undergo longitudinal ultrasonic motion from the transducer assembly 114 and total rotational motion from the motor. have. For example, two to ten revolutions per cycle (720 to 3600 degrees) of rocking motion or continuous one-way rotation can be achieved. Those skilled in the art will readily appreciate that various embodiments of the surgical system 10 can be effectively used with arthroscopy and other surgical applications.

At least one non-limiting embodiment can further include a control device 170 on the housing 102. See FIG. Control device 170 may communicate with control module 24 by multi-conductor cable 171. The control device 170 may include a first button 172 for activating / deactivating the "dual" mode, including "ultrasound mode" and "rotation mode". In such an apparatus, the control module 24 may be preprogrammed to provide a predetermined amount of total rotational motion to the blade 200. The control device 170 may further include a second button 174 for cutting without hemostasis by activating / deactivating the rotation mode without activating the ultrasound mode. The control device 170 may also include a third button 176 to activate / deactivate the "solidification mode", where the motor 190 drives in a predetermined rotational orientation and then "parks". Or deactivated to expose the ultrasonic blade surface at the distal end of outer sheath 240 as discussed in further detail below. Also, in this mode, the ultrasound transducer assembly 114 may be powered to provide spot coagulation, or in alternative embodiments the clinician may simply provide an ultrasound transducer for a predetermined period of time, for example 5 seconds. The spot coagulation button 77, which activates the producer assembly 114, may be activated. The control device may further include a button 178 for switching between the ultrasound mode and the rotation mode. According to various non-limiting embodiments, any combination of the above-described functions / modes can be combined and controlled by one or more buttons without departing from the spirit and scope of the various non-limiting embodiments and their equivalent structures disclosed herein. Can be.

Those skilled in the art can be configured to operably support a variety of different types and shapes of ultrasonic handpieces therein that the housing member 102 and the mounting adapters 130, 134 can be separated from the surgical instrument 100 and used independently. I will understand. Accordingly, control system 20 and instrument 100 allow buyers to install their existing ultrasonic handpieces therein without departing from the spirit and scope of the various non-limiting embodiments and their respective equivalent structures disclosed herein. It may be provided in "kit form" without the ultrasonic handpiece 110 to facilitate this.

6 and 7 illustrate another surgical instrument 300, wherein the same reference numerals previously used to describe the various embodiments discussed above are used to indicate the same components. In these embodiments, surgical instrument 300 includes a housing 302 that houses a transducer assembly 314 attached to an ultrasonic horn 324. The ultrasonic horn 324 can be coupled to the proximal end 201 of the blade 200 in the manner described above. Ultrasonic horn 324 may be rotatably supported in housing 302 by distal bearing 336. The nosepiece 160 may be attached to the housing 302 by the fastener 161 in the manner described above.

In this embodiment, the ultrasonic transducer assembly 314 has a magnet 316 embedded, otherwise attached or otherwise attached to form an integral motor rotor, generally designated 320. A motor stator ring 330 is mounted in the housing 302 as shown. Conductors 332 and 334 are attached to motor stator ring 330 and pass through common sheath 76 to attach to motor cable 33 in control system 20 as described above. The hollow shaft 340 extends through the motor rotor 320 to form a passageway for the conductors 151, 152. Conductors 151 and 152 are coupled to ultrasonic transducer assembly 314 and internal contacts 154. The inner contact 154 is attached to a portion of the hollow shaft 340 that rotatably extends into the slip ring assembly 150 that is also supported within the housing 302. The hollow shaft 340 is rotatably supported in the housing 302 by the proximal bearing 342. The slip ring assembly 150 is fixed in the housing 302 (ie non-rotable) and fixed external contacts coupled to the conductors 157, 158 forming the generator cable 14 as described above. 156). When power is supplied to the motor stator 330, the rotor 320 and the integrated ultrasonic transducer 314 rotate about axis A-A. The ultrasonic signal from the ultrasonic generator 12 is transmitted to the internal contact 154 by a rotary contact or electrical communication between the internal contact 154 and the external contact 156. These signals are transmitted by the conductors 151, 152 to the ultrasonic transducer assembly 314. Surgical instrument 300 may include a control device of the type described above and may be used in the various modes described above. Suction may be applied between the blade 200 and the outer sheath 230 through the port 240. Collection receptacle 243 and suction source 240 may be attached to port 240 by tube 242. The distal end of the blade is exposed through a window in the distal end of the outer sheath 230 to expose the blade to tissue as further discussed below.

8 illustrates another surgical instrument 400, wherein the same reference numerals previously used to describe the various embodiments discussed above are used to indicate the same components. In these embodiments, surgical instrument 400 includes a housing 302 that houses an ultrasonic transducer assembly 314 attached to an ultrasonic horn 324. The ultrasonic horn 324 can be coupled to the proximal end 201 of the blade 200 in the manner described above. Ultrasonic horn 324 may be rotatably supported in housing 302 by distal bearing 336. The nosepiece 160 may be attached to the housing 302 in the manner described above.

In this embodiment, a brushed motor 410 is integrally attached to the ultrasonic transducer assembly 314. As used herein, “integrally attached” means attached directly to, or otherwise formed with, the ultrasonic transducer assembly 314 to travel together. The term " integrally attached " as used in connection with the attachment of the brushed motor 410 to the ultrasonic transducer assembly 314 includes such a configuration in which the ultrasonic transducer assembly is attached to the motor via a driven shaft device. I do not. Also in this embodiment, a magnet 426 is provided in the stator ring 420 secured in the housing 302. Conductors 432 and 434 extend through hollow shaft 340 attached to brushed motor 410. The hollow shaft 340 is rotatably supported in the housing 302 by the proximal bearing 342. Motor conductor 432 is attached to first internal motor contact 436, and motor conductor 434 is attached to second internal motor contact 438. First and second internal motor contacts 436, 438 are supported on portions of the hollow shaft 340 that extend into the slip ring assembly, generally indicated at 450. Slip ring assembly 450 is secured within housing 302 (ie, non-rotable) and has a first external motor contact 440 coupled to conductor 441 and a second coupled to conductor 443. An external motor contact 442. Conductors 441 and 443 form motor cable 74 as described above. When the clinician wants to apply a total rotational motion to the ultrasonic transducer assembly 314 and finally to the blade 200, the clinician causes power to be supplied from the motor drive 26 to the brushed motor 410. .

Also in this embodiment, the conductors 151, 152 are attached to the ultrasonic transducer assembly 314 and extend through the hollow shaft 340 to attach the internal transducer contacts 154 to the hollow shaft 340. Is coupled to the Slip ring assembly 450 includes a fixed external transducer contact 156 coupled to conductors 157 and 158 forming generator cable 14 as described above. When power is supplied to the brushed motor 410, the motor 410, the ultrasonic transducer assembly 314, and the motor shaft 340 rotate about axis A-A. The ultrasonic signal from the ultrasonic generator 12 is transmitted to the inner contact 154 by a rotary sliding contact or electrical communication between the inner contact 154 and the outer contact 156. These signals are transmitted by the conductors 151, 152 to the ultrasonic transducer assembly 314. Surgical instrument 400 may include a control device of the type described above and may be used in the various modes described above. It will be appreciated that the instrument 400 can be used in rotation mode, ultrasound mode, rotation and ultrasound mode (“dual mode”) or coagulation mode as described above. Suction may be applied between the blade 200 and the outer sheath 230 through the port 240. Collection receptacle 243 and suction source 240 may be attached to port 240 by tube 242. The distal end of the blade is exposed through a window in the distal end of the outer sheath 230 to expose the blade to tissue as further discussed below.

9-13 illustrate another surgical instrument 500, wherein the same reference numerals used previously to describe the various embodiments discussed above are used to indicate the same components. In these embodiments, surgical instrument 500 includes a housing 302 that houses a transducer assembly 530 attached to an ultrasonic horn 324. The ultrasonic horn 324 can be coupled to the proximal end 201 of the blade 200 in the manner described above. Ultrasonic horn 324 may be rotatably supported in housing 302 by distal bearing 336. The nosepiece 160 may be attached to the housing 302 in the manner described above.

This embodiment includes a motor 510 that may include a stepper motor of the type and configuration described above and may have an encoder portion associated therewith in communication with the control module 24 as described above. The motor 510 may receive power from the motor driver 26 via conductors 511 and 512 including a motor cable 74 extending through the common sheath 76. Motor 510 has a hollow motor shaft 520 attached thereto that extends through slip ring assembly 150. The hollow drive shaft 520 is rotatably supported in the housing 302 by the proximal bearing 342. The slip ring assembly 150 is fixed in the housing 302 (ie non-rotable) and fixed external contacts coupled to the conductors 157, 158 forming the generator cable 14 as described above. 156). An internal contact 154 is mounted on the hollow drive shaft 520 and is in electrical contact or communication with the external contact 156. Conductors 151, 152 are attached to internal contacts 154 and extend through hollow drive shaft 520 and are coupled to ultrasonic transducer assembly 530.

In various embodiments, to facilitate ease of assembly and to acoustically disconnect the motor from the ultrasonic transducer assembly 530, the hollow drive shaft 520 is ultrasonically coupled by a coupling assembly, indicated generally at 540. It may be detachably coupled to the transducer stack 530. As can be seen in FIGS. 9, 11, and 12, the coupling assembly 540 may include a thin plate member 542 attached to the distal end 521 of the hollow drive shaft 520. The thin plate member 542 can be made from a material having relatively low rigidity in the axial direction and high rigidity at rotation. See FIG. For example, the thin plate member 542 may be made from 0.08 cm (0.008 inch) thick aluminum 7075-T651, and the distal end 521 of the hollow drive shaft 520 by, for example, interference fit or brazing. ) Can be attached. Coupling assembly 540 may further include a proximal end mass or flange portion 531 of ultrasonic transducer assembly 530. Proximal end mass 531 may comprise a flange, for example made from stainless steel, attached to ultrasonic transducer assembly 530 by, for example, bolting or other connection. As can be seen in FIG. 11, the end mass 531 has a hole 532 sized to receive the thin plate member 542 therein. In various embodiments, the thin plate member 542 is sized to press into the hole 532 such that the ultrasonic transducer assembly 530 rotates about the axis AA by rotation of the thin plate member 542 about the axis AA. Can be. In another embodiment, a separate fastener plate (not shown) or snap ring (not shown) or snap feature (not shown) is in non-rotatable engagement with the end mass 531 of the ultrasonic transducer assembly 530. It may be provided to hold the thin plate member 542. Such a configuration serves to minimize the transmission of sonic vibrations from the ultrasonic transducer assembly to the motor.

14 and 15 illustrate alternative thin plate members 542 'that may be used. In this embodiment, the thin plate member 542 ′ has a plurality of radial notches 544 provided therein to form the radial tabs 546. A notch (not shown) will be formed in the hole 532 to receive the radial tab 546 therein. Such a configuration can reduce the moment force applied to the shaft 520. By using the thin plate members 542, 542 ′, the amount of acoustic vibration transmitted from the ultrasonic transducer assembly 530 to the drive shaft 520 can be minimized.

When power is supplied to the motor 510, the drive shaft 520 rotates about axis A-A and also causes the transducer assembly 530 to rotate about axis A-A. When the clinician desires to power the ultrasound transducer assembly 530, power is supplied from the ultrasound generator 12 to the fixed contact 156 in the slip ring assembly 150. Power is transmitted to the ultrasonic transducer assembly 530 by rotary sliding contact or electrical communication between the inner contact 154 and the outer contact 156. These signals are transmitted to the ultrasonic transducer assembly 530 by conductors 151 and 152. Surgical instrument 500 may include a control device of the type described above and may be used in the various modes described above. It will be appreciated that the instrument 400 can be used in rotation mode, ultrasound mode, rotation and ultrasound mode (“dual mode”) or coagulation mode as described above. Suction may be applied between the blade 200 and the outer sheath 230 through the port 240. Collection receptacle 243 and suction source 240 may be attached to port 240 by tube 242. The distal end of the blade is exposed through a window in the distal end of the outer sheath 230 to expose the blade to tissue as further discussed below.

16 illustrates another surgical instrument 600, wherein the same reference numerals previously used to describe the various embodiments discussed above are used to indicate the same components. In these embodiments, surgical instrument 600 includes a housing 302 that houses a transducer assembly 314 attached to an ultrasonic horn 324. In this embodiment, the transducer assembly 314 and the ultrasonic horn 324 are attached to the PZT housing 602 which is rotatably supported in the housing 302 by the distal bearing 336. The ultrasonic horn 324 can be coupled to the proximal end of the blade 200 in the manner described above. The nosepiece 160 may be attached to the housing 302 by the fastener 161 in the manner described above.

This embodiment includes a motor 510 that may include a stepper motor of the type and configuration described above. Motor 510 may have an encoder associated therewith in communication with control module 24 (FIG. 1) as described above. Motor 510 may receive power from motor drive 26 (FIG. 1) via conductors 511, 512 including motor cable 74 extending through common sheath 76. Motor 510 has a hollow motor shaft 520 attached thereto that extends through slip ring assembly 150. The hollow drive shaft 520 is rotatably supported in the housing 302 by the proximal bearing 342.

The slip ring assembly 150 is fixed in the housing 302 (ie non-rotable) and fixed external contacts coupled to the conductors 157, 158 forming the generator cable 14 as described above. 156). An internal contact 154 is mounted on the rotatable hollow drive shaft 520 and is in electrical contact or communication with the external contact 156. Conductors 151 and 152 are attached to internal contacts 154 and extend through hollow drive shaft 520 and are coupled to ultrasonic transducer assembly 314. In various embodiments, to facilitate ease of assembly and to acoustically disconnect the motor 510 from the ultrasonic transducer assembly 314, the hollow drive shaft 520 is generally coupled to the coupling assembly 540. Can be detachably coupled to the PZT housing 602. The coupling assembly 540 can include a thin plate member 542 attached to the distal end 521 of the hollow drive shaft 520. As discussed above, the thin plate member 542 is relatively low in axial direction. It can be made from a material having high stiffness in stiffness and rotation. The PZT housing 602 has a proximal end portion 604 having a hole 603 sized to receive the thin plate member 542 therein. In various embodiments, the thin plate member 542 is configured such that the PZT housing 602 and the ultrasonic transducer assembly 314 and the ultrasonic horn 324 move the axis AA by rotation of the thin plate member 542 about the axis AA. It may be sized to be pressed into the hole 603 to rotate about the center. In another embodiment, a separate fastener plate (not shown) or snap ring (not shown) or snap feature (not shown) is a non-rotatable engagement with the proximal end portion 604 of the PZT housing 602. It may be provided to hold the thin plate member 542. This embodiment may also utilize the thin plate member 542 'as discussed above.

When power is supplied to the motor 510, the drive shaft 520 rotates about axis A-A, and also causes the PZT housing 602 and ultrasonic transducer assembly 314 to rotate about axis A-A. When the clinician desires to power the ultrasound transducer assembly 314, power is supplied from the ultrasound generator 12 to the fixed contact 156 in the slip ring assembly 150. Power is transmitted to the ultrasonic transducer assembly 314 by rotary sliding contact or electrical communication between the inner contact 154 and the outer contact 156. These signals are transmitted by the conductors 151, 152 to the ultrasonic transducer assembly 314. Surgical instrument 500 may include a control device of the type described above and may be used in the various modes described above. It will be appreciated that the instrument 400 can be used in rotation mode, ultrasound mode, rotation and ultrasound mode (“dual mode”) or coagulation mode as described above. Suction may be applied between the blade 200 and the outer sheath 230 through the port 240. Collection receptacle 243 and suction source 240 may be attached to port 240 by tube 242. The distal end of the blade is exposed through a window in the distal end of the outer sheath 230 to expose the blade to tissue as further discussed below.

In an effort to reduce the overall size of the housing 302 used in each of the instruments 300, 400, 500, and 600, the ultrasonic transducer assembly used in each of these instruments is a physically shorter half wave transducer ( half wave transducer).

Ultrasonic Blades and Sheaths Examples

Current arthroscopic tools include punches, reciprocating shavers, and radio frequency (RF) powered devices. Mechanical devices such as punches and razors tend to produce minimal tissue damage, but can sometimes leave undesired rough cuts. RF-powered blades can remove large amounts of soft tissue while leaving smoother cut lines. However, such devices can produce more tissue damage than pure mechanical instruments. The various non-limiting surgical instrument embodiments described above provide a number of advantages over conventional RF powered surgical instruments as well as conventional mechanical razors that utilize rotating tissue cutting members. As discussed in further detail below, additional advantages may be realized by utilizing the unique and novel blade and sheath configurations of various non-limiting embodiments.

17-21 illustrate one form of blade 200 and outer sheath 230 that may be used with the various surgical instruments described above. As can be seen in these figures, the blade 200 can have a distal end portion 700 and the outer sheath 230 can have a distal end portion 720. Blade 200 may be made from titanium, for example, and outer sheath 230 may be made from polyether ether ketone (“PEEK”), Ultem®, or stainless steel, for example. Can be. As discussed above, the blade 200 may have a waveguide or proximal end portion configured to be threadably or otherwise attached to the ultrasonic horn 324 (FIGS. 6-10 and 16) in a known manner. Distal end portion 700 of blade 200 may have a curved tip portion 702 formed thereon. The curved tip 702 can have an arcuate upper segment 704 with a cutting edge 706 formed on each lateral side 705. The cutting edge 706 may terminate distal at the common, substantially pointed distal end 708. The pointed distal end 708 may be relatively blunt, or the pointed distal end 708 may have a point that is relatively sharpened. As can be seen in FIG. 20, the pointed distal end 708 can be curved inward with respect to the central axis A-A of the blade. As can be seen in FIG. 19, in various embodiments, the cutting edges 706 may not intersect with each other and may be separated by the central portion 707. As can be seen in FIG. 20, the blade 200 can have a reduced neck portion 710 projecting distal from the waveguide or proximal blade portion 712. Node 714 may be established in an area where neck portion 710 protrudes from proximal portion 712.

As can be seen in FIG. 17, the outer sheath 230 also has a distal end portion 720 having a window or opening 722 formed therein to expose the distal end portion 700 of the blade 200. Have As can also be seen in FIG. 17, the outer sheath 230 can include a hollow cylinder having a substantially blunt end 724. In various embodiments, the window 722 extends about half of the circular cross section of the sheath 230. Such window configuration forms an arcuate ledge 725 extending around the blunt end 724. In various embodiments, the outer sheath 230 can be made, for example, from poly ether ether ketone (“PEEK”), Ultem®, or stainless steel. In order to prevent metal-to-metal contact between the cutting edge 706 and the ledge 725 on the distal end portion 700 of the blade 200, a polymer fender 726 is, for example, an adhesive or ledge ( 724) by a T-slot around. See FIG. 17. Fender 726 may be made from, for example, Teflon®, silicone or other reduced or "low friction" material. The fender 726 may be sized to produce, for example, an interference fit of 0.013 cm (0.005 inch) with the cutting edge 706 and the pointed distal end 708.

In use, as the blade 200 is rotated about the axis AA in the outer sheath 230 and introduced into the tissue, the tissue is wound into the inner sheath 220 (FIG. 4) and the outer sheath 230 as described above. Aspirated into the window 722 by suction applied between. Thereafter, tissue drawn into the window 722 is cut as the cutting edge 706 is rotated past the fender 726, and the cut tissue passes between the inner sheath 220 and the outer sheath 230 and is sucked in. It may be discharged to the collection receptacle 243 (FIGS. 4, 6-10, and 16) through the port 240 (FIGS. 4, 6-10, and 16).

In another embodiment, an axial suction passage 730 may be provided through the neck portion 710 of the blade 200. See FIG. 20. The axial suction passage 730 may communicate with the lateral suction passage 732 in the region of the node 714. Thus, the cut tissue passes through passages 730 and 732 between the inner sheath 220 and the outer sheath 230 and through the suction port 240 (FIGS. 4, 6-10, and 16). May be discharged to the collection receptacle 243 (FIGS. 4, 6-10, and 16). FIG. 21 illustrates an alternative embodiment in which two outlet passages 734, 736 communicate with and extend at an angle from the axial passage 730. In various embodiments, the outlet passages 734, 736 can extend from the axial passage 730, for example, at an angle 738 of 45 degrees. Such a configuration can serve to reduce impedance and power loss during ultrasonic operation, which can otherwise result from water drawn into it through the window 722 in the outer sheath 230.

In use, the clinician may choose to rotate the blade 200 within the outer sheath 230 without applying ultrasonic motion thereto. The clinician may also choose to apply ultrasonic motion to the rotating blade, or the clinician may ultrasound the blade in a standby (non-rotating) position to use the portion of the blade exposed in the window 722 to solidify the tissue. You may want to apply exercise.

22 illustrates the use of a blade 200 with an outer sheath 230 having a distal end portion 750 that includes a distal protruding nose segment 752. In various embodiments, the nose segment 752 may have an arcuate width “W” that includes approximately 10 to 30 percent of the circumference of the distal end portion 750 of the outer sheath 230. The nose segment 752 may protrude distal from the end of the distal end portion 750 of the sheath 230 to a length “L”, which may be, for example, approximately 0.64 cm (0.25 inch). In alternative embodiments, low friction fenders or guards (not shown) may be applied to the side 753 of the nose segment 752, if desired. These embodiments may operate in a manner similar to the previous embodiment. However, this embodiment has the added ability to cut tissue with an exposed tip. As in other embodiments, the clinician may apply the overall rotational motion to the blade 200, with or without ultrasonic motion. In another alternative method of use, the exposed tip 708 and the partially exposed cutting edge 706 can be used to cut tissue when the blade is not rotating or vibrating.

23 and 24 illustrate another non-limiting blade and outer sheath embodiment. In this embodiment, the blade 200 has a distal end portion 760 that is substantially similar to the distal end portion 700 of the blade configuration described above. However, distal blade portion 760 is not bent inwardly to the same extent such that blade tip 762 does not intersect central axis A-A. See FIG. 24. As can be seen in FIG. 23, the window 722 ′ of the distal end portion 720 of the outer sheath 230 does not extend the entire distance from the end wall 725 to the blunt tip 724. Thus, in this embodiment, blunt tip 724 includes a nose that extends above 90 ° but below 180 ° (ie, angle “A” in FIG. 23A is above 90 ° but below 180 °).

25 and 26 illustrate another non-limiting blade embodiment. In such an embodiment, the blade 200 'may be substantially similar to the blade 200 or any other blade described herein. In this embodiment, the distal end 700 'has a roughened top surface 705'. Such roughened surface 705 ′ creates a higher friction force between the distal end portion 700 ′ of the blade 200 ′ and the tissue to allow the window 722 ′ of the distal end portion 720 of the outer sheath 230. The tissue is aspirated into (Figure 26). By pulling more tissue into the window 722, the tip cutting edge 706 ′ of the blade 200 ′ may have a higher likelihood of cleanly cutting the tissue. In various embodiments, for example, the roughened surface may be formed by knurling, or the upper surface may be coated with a hard material such as diamond or the like.

27-29 illustrate another non-limiting blade embodiment. In such an embodiment, the blade 200 "may be substantially similar to the blade 200 described herein. In this embodiment, the distal end 700" has a blade 200 "with an outer sheath 230 Has a row of radially extending cutting teeth 707 that protrude outwardly from the top surface 705 " to pull and cut tissue as it is rotated within.

30, 31 and 32A-32D illustrate another non-limiting blade and outer sheath embodiment. During the use of various instruments utilizing rotatable blades in the outer sheath, it has been found that tissue can be "kicked out" from the sheath window as the blade rotates inward. This can lead to reduced cutting speed since tissue is not properly captured and retained between the cutting edges. The blade 800 of this embodiment solves that potential shortcoming.

As can be seen in FIG. 30, the blade 800 can be substantially the same as the blade 200 except for the differences mentioned herein. In particular, the blade 800 may include a neck portion 803 that terminates at the distal end portion 810. Distal end portion 810 may have a somewhat curved tip 812. One row of teeth 817 may be provided on at least one lateral side 813 or 815 of distal end portion 810. In the embodiment shown in FIGS. 32A-32D, teeth 817, 819 are formed on each lateral side 813, 815 of distal end portion 810. Distal end portion 810 further has a somewhat domed upper portion 821. In the embodiment shown in FIGS. 30-32D, the teeth 817 include relatively sharp points that define a series of arcuate openings 823 therebetween. The teeth 819 also include relatively sharp points with a series of arcuate openings 825 therebetween. As shown in FIG. 30, an axial suction passage 805 may be provided through the neck portion 803 of the blade 800. The axial suction passage 805 may communicate with the lateral suction passage 807 in the region of the node 808. Thus, the cut tissue may exit the inner sheath (not shown) and the outer sheath 850 through passages 805 and 807 in the manner described herein above and out through the suction port to the collection receptacle. Other intake path configurations can also be used successfully.

The outer sheath 850 may be substantially similar to the outer sheath 230 described above, having a window or opening 854 formed therein to expose the distal end portion 810 of the blade 800. It may have an attached distal sheath tip 852. See FIG. 31. The outer sheath 850 may comprise a hollow cylinder made from, for example, stainless steel. In various embodiments, the window 854 extends about approximately half of the circular cross section of the sheath 850 and forms a blade opening 858 therein. Distal sheath tip 852 may be made from a metal, such as stainless steel, for example, such that relatively sharp cutting edge 860 extends around blade opening 858. For illustrative purposes, the sharp cut edge 860 has a first lateral cut edge portion 862 and a second lateral cut edge portion 864.

32A-32D illustrate the sequential rotation of the blade 800 within the outer sheath 850. Referring first to FIG. 32A, the blade 800 is shown to be rotated counterclockwise (“CCW”). As shown in the figure, the cutting tooth 817 on the first lateral side 813 of the blade 800 is the first lateral cutting edge portion 862 of the tooth 817 and the cutting edge 860. ) To shear the tissue (not shown). When in that position, the arcuate opening 823 between the teeth 817 is exposed to collectively form a first lateral suction path 870 between the blade 800 and the distal sheath tip 852. This allows tissue to be sucked into it by suction applied through suction passage 805 (FIG. 30). As the rotation sequence continues, the domed upper portion 821 of the blade 800 covers the opening 854 in the distal sheath tip 852 such that there is no exposed suction path through which tissue enters the opening 854. As the blade continues to rotate, FIG. 32C shows that the arcuate opening 825 between the teeth 819 causes a second lateral suction path 872 between the second lateral cut edge portion 864 and the blade 800. ) Collectively to enable tissue to be sucked into it. As the blade 800 continues to rotate in the CCW direction, the third suction path 874 is exposed, allowing tissue to be further sucked into the opening 854. Thus, such a configuration allows for sequential opening of the suction path from one lateral side of the blade opening 858 to the other lateral side, thereby facilitating better tissue cutting. In use, the clinician may choose to rotate the blade 800 within the outer sheath 850 without applying ultrasonic motion thereto. The clinician may also choose to apply ultrasonic motion to the rotating blade, or the clinician may use the portion of the blade exposed in the opening 854 to solidify the tissue to a standby (non-rotating) blade. You may want to apply ultrasound exercise.

33 and 34 illustrate another blade embodiment 880, which may be substantially the same as the blade 200 except for the differences noted below. In particular, the blade 880 may include a waveguide or proximal portion 882 terminating at the distal tissue cutting portion 884. The proximal portion 882 of the blade 880 may be configured to be threadably or otherwise attached to the ultrasonic horn of any of the various embodiments discussed above. Distal tissue cutting portion 884 may have opposing arcuate channels 886, 888 formed therein. The first arcuate channel 886 can define a first cut edge 890, and the second arcuate channel 888 can define a second cut edge 892. Such blade embodiments can be used with any of the external sheath configurations described above. In the illustrated embodiment, the hollow outer sheath 900 may be similar to the sheath 230 and includes a distal sheath tip 901 having a rounded or blunt nose portion 902 and a window 904. Is used. The hollow outer sheath 900 can be made from, for example, stainless steel, and the distal sheath tip 901 can be made from a metal, such as, for example, stainless steel. Window 904 is an arcuate cutting edge 906 that cooperates with cutting edges 890, 892 on blade 880 to shear out tissue as blade 880 is rotated within outer sheath 900 in the various manners described above. ). In at least one embodiment, the proximal portion 882 of the blade 880 is provided with respect to the hollow outer sheath 900 such that a gap is provided between them to enable suction to be applied thereto, for example in the manner described above. It may be size. As can be seen in FIG. 34, as the blade 880 rotates (indicated by arrow “R”), the arcuate channels 886, 886 become distal end 884 and distal sheath tip (of blade 880). Define openings 894, 896 between the walls of 901 so that tissue is applied to the suction applied to the area between the inner wall of the outer sheath 900 and the neck 882 of the blade 800 (arrow “S”). It is possible to aspirate into it). It will also be appreciated that the blade 880 may be rotated counterclockwise or clockwise, or may be selectively rocked between such rotational directions to more effectively cut tissue sucked into it. 34A illustrates an alternative sheath tip embodiment 901 having a row of serrated cut teeth 905 'made from a metal material such as, for example, stainless steel and formed on each cut edge 890', 892 '. Show ').

35 illustrates another blade embodiment 910, which may be substantially the same as blade 200 except for the differences noted below. In particular, the blade 910 may include a waveguide or proximal portion 912 terminating at the distal tissue cutting portion 914. Proximal portion 912 of blade 910 may be configured to be threadably or otherwise attached to the ultrasonic horn of any of the various embodiments discussed above. Distal tissue cutting portion 914 may have opposing channels 916 formed therein and cooperating to define a first cutting edge 920 and a second cutting edge 922. Such blade embodiments can be used with any of the various outer sheath configurations described above and are designed to rotate in only a single direction "R" for tissue cutting purposes. As in the embodiment described above, the arcuate channel 916 defines an opening between the tissue cutting portion 914 of the blade 910 and the inner wall of the distal sheath tip, such that the inner wall of the proximal portion 912 and the outer sheath. As suction is applied to the area between the tissues, it becomes possible for the tissue to be sucked into it.

36 illustrates another surgical instrument 2000, wherein the same reference numerals used previously to describe the various embodiments discussed above are used to indicate the same components. In these embodiments, surgical instrument 2000 includes a housing 302 that houses an ultrasonic transducer assembly 314 attached to ultrasonic horn 324. In such embodiments, the ultrasonic transducer assembly 314 and the ultrasonic horn 324 may be non-rotatably supported within the housing 302 in a known manner. Electrical control signals may be supplied from the ultrasonic generator 12 to the ultrasonic transducer assembly 314 by conductors 151, 152. The operation of the ultrasonic generator 12 will cause the ultrasonic transducer assembly 314 to apply ultrasonic motion to the ultrasonic horn 324. In this embodiment, the hollow outer sheath 2010 is coupled to the ultrasonic horn 324 to receive ultrasonic motion therefrom. For example, in various embodiments, the outer sheath 2010 can be coupled to the ultrasonic horn 324 by threaded connection or other suitable fastening device.

This embodiment includes a rotatable blade 2020 that is rotatably supported in the outer sheath 2010 and coupled to a motor 510 supported in the housing 302. Motor 510 may include, for example, a stepper motor of the type and configuration described above. Motor 510 may have an encoder associated therewith in communication with control module 24 (FIG. 1) as described above. The blade 2020 may have a hollow distal portion 2022 and a solid proximal portion 2024. See FIG. 36A. The solid proximal portion 2024 may be attached to the motor drive shaft 520 by threaded or other suitable connection. The motor drive shaft 520 may be rotatably supported in the housing 302 by the proximal bearing 342. When a control signal is supplied to the motor 510, the drive shaft 520 rotates about axis A-A, which also causes the blade 2020 to rotate about axis A-A within the outer sheath 2010.

As can also be seen in FIG. 36A, the hollow outer sheath 2010 is supported in a hollow nosepiece 160 having a suction port 240 therein. The flexible tube 242 can be attached to the suction port 240 and in communication with a collection receptacle 243 coupled to the suction source, shown generally at 244. The hollow sheath 2010 is located on each side of the suction port 240, as shown in FIG. 36A, and proximal seal 2013 and distal seal 2015, which serve to establish a liquid tight seal therebetween. It can be supported in the nosepiece 160 by. The hollow sheath 2010 is provided with at least one proximal sheath opening 2014 that is aligned with the suction port 240 between the proximal seal 2013 and the distal seal 2015. In addition, the hollow distal portion 2022 of the blade 2020 is rotatably supported in the hollow sheath 2010 by at least the proximal blade seal 2025 and the distal blade seal 2027. Hollow portion 2022 of blade 2020 between proximal blade seal 2025 and distal blade seal 2027 for discharging at least one blade discharge port 2028 into at least one proximal sheath opening 2014. Can be provided through.

Also in various embodiments, the distal end portion 2011 of the hollow outer sheath is closed and at least one opening or window 2012 is exposed therein to expose the distal tissue cutting portion 2025 of the blade 2020. Is provided. In at least one embodiment, the window 2012 includes an elongated slot and the distal tissue cutting portion also includes an elongated slot 2026 (FIGS. 37 and 38) in the blade 2020. Thus, suction may be applied from the suction source 244 into the hollow portion of the blade 2020 through the port 240, the proximal sheath opening 2014 and the blade discharge port 2028. As the distal openings 2026, 2012 coincide, tissue “T” may be sucked into the hollow distal portion 2022 of the blade 2020, as shown in FIG. 38. The cut portion of tissue “T” may pass through hollow distal portion 2022 of blade 2020 and exit through collection 2028, 2014 into collection receptacle 243.

In use, the clinician can operate the rotating blade 2020 to cut and eject tissue. Upon encountering the bleeder, the clinician can operate the ultrasound transducer assembly 314 to supply ultrasound motion to the external sheath 2010 for coagulation purposes. For example, spinal fusion surgery requires removal of disc material due to various disease states. Often these materials become hard, requiring considerable force by the use of conventional instruments to destroy the disk and remove its fragments. Once the disk material is removed, the end plates must be scraped to reveal the new surface to facilitate the fusion of the plates into the cage. The plates must also be shaped to provide a good fit with the type of cage used. The use of conventional instruments generally requires high forces from surgeons who are very close to critical structures. In another embodiment, the motor may be coupled to rotate the ultrasonic transducer assembly, and the blade may be attached to the ultrasonic transducer assembly as described above and rotated to allow the blade to rotate.

The use of the surgical instrument 2000 described above may be particularly advantageous when performing disctomy, for example as shown in FIGS. 39 and 40. As can be seen in these figures, the outer sheath 2010 can be inserted into the disc " D ". Rotating blade 2020 can be used to scrape small pieces of disk and suck them out. This configuration eliminates the need for repeated insertion / removal of surgical tools. The device can also be used to prepare vertebrae endplates. In the embodiment shown in FIGS. 41-45, the rotatable cutting blades 2020 may be provided with a distal opening (not shown) to further aid in the cutting of tissue sucked into it through the opening 2012 in the outer sheath 2010. It has a row of toothed teeth 2021 formed on at least one side of 2026. Also in this embodiment, the retractable safety shield 2040 is movably mounted on the outer sheath 2010 and opens from the closed position 2012 substantially covering the opening 2012 in the outer sheath 2010. Can be selectively moved up to an open position exposing () (FIGS. 43 and 44). Such a configuration covers the teeth 2021 of the blade 2020 during insertion and removal of the outer sheath 2010 adjacent to nerves and other vital tissues essential for life support. To facilitate movement of the safety sheath 2040 on the outer sheath 2010, the thumb control tab 2042 (FIGS. 41 and 45) allows the clinician to apply a sliding actuation force thereto. ) On the proximal end. Further, in various embodiments, retainer protrusion 2044 engages at least one stop or groove 2046 provided in outer sheath 2010 to retain safety sheath 2040 in a corresponding open or closed position. It may be formed on the safety sheath 2040. For example, one stop or groove 2046 may correspond to a closed position, where the safety sheath 2040 covers the opening 2012, and the other stop or groove 2046 ′ is partially. In an open position, where a portion of the opening 2012 is exposed, and in a position where the other stop or groove 2046 "is fully open, where the opening 2012 is fully exposed. It can respond.

46-51 illustrate a blade 940 having a nearly straight distal tissue cutting portion 942. Such blade configurations can reduce potential impedance and power increase when the blade 940 is used in an aqueous environment, compared to the impedance and power requirements of various other blade configurations when used in such an environment. That is, such a relatively straighter blade design may require less power to operate in an aqueous environment. The blade 940 has a round or blunt distal end 944 and grooves 946 that form cutting edges 947, 948 for cutting tissue when the blade 940 is used with the outer sheath 230 as described above. ) The groove can have a length “L” of, for example, 2.54 cm (1 inch). The blade 942 may also have a suction passage 730 of the type and configuration described above. As shown in FIG. 47, a low friction fender or pad 726 of the type and configuration described above may be used around the exposed distal end portion 720 of the outer sheath 230. 48-51 illustrate alternative cross-sectional shapes of the blade 940 where other shaped grooves 946 are used.

52-55 illustrate other non-limiting blade and sheath embodiments. This embodiment utilizes a hollow outer sheath 950 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the surgical instruments described above by any suitable fastening method or connection device. As can be seen in FIG. 55, the outer sheath 950 has a closed rounded or blunt nose portion 952 and a long rectangular shaped window or opening 954. In one embodiment, for example, the rectangular shaped window 954 has a width "W" that is approximately one quarter of the circumference of the hollow outer sheath 950 and a length of approximately 0.64 cm (0.25 inch). The sheath 950 can be made from stainless steel, for example.

This embodiment also utilizes a blade 960 that can be used with any of the surgical instrument embodiments described above or others. For example, the waveguide or proximal portion of the blade may be configured to be attached to the ultrasonic horn or motor drive shaft of the instrument by threaded or other connection. As can be seen in FIGS. 52-54, the blade 960 serves to cut a tissue “T” sucked into the window 954 of the outer sheath 950, a pair of radially formed thereon. With sharp cutting edges 962 opposite. In various embodiments, the blade 960 may be made, for example, from titanium, with sharp cutting edges 962 with a gap “C” radially opposite the inner wall 951 of the outer sheath 950. It may have a size for the outer sheath 950 to be provided between the tips of the. See FIG. 54. In some embodiments, for example, the gap “C” may be approximately 0.0025 cm (0.001 inches). In such an embodiment, the blade 960 may be made from titanium, for example, and may have a flattened distal end 964. In use, when total rotational motion is applied to the blade 960 in any of the various manners described above and suction is applied into the hollow outer sheath 950, tissue “T” is sucked into it through the window 954. And is collected between the blade 960 and the inner wall 951 of the outer sheath 950. This action separates tissue “T” long enough to be cut when the device is used in an aqueous environment, for example, as discussed in further detail below. In some embodiments, cutting edge 962 may be serrated. In other embodiments, the cutting edge 962 is not serrated.

57 illustrates another non-limiting blade and sheath embodiment. This embodiment utilizes a hollow outer sheath 970 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the various instruments described above. As can be seen in FIG. 56, the outer sheath 970 has a rounded or blunt nose portion 972, and blade access within the nose portion 972 and two radially opposite lateral window portions 978. It has an elongate window or opening 974 forming a hole 976. For example, in one embodiment where the outer sheath 970 has an outer diameter of approximately 0.399 cm (0.157 inches), the diameter of the blade access hole 976 can be approximately 0.318 cm (0.125 inches). Lateral window portions 978 may each have a width "W" of approximately 0.23 cm (0.090 inch) and a length "L" of approximately 0.64 cm (0.25 inch). Other window sizes / configurations may be used. Sheath 970 can be made from, for example, stainless steel.

This embodiment also utilizes a blade 980 having a waveguide or proximal portion configured to be attached to the ultrasonic horn 324 or motor drive shaft of any of the various surgical instrument embodiments described above by screwing or other suitable connection. In various embodiments, the blade 980 except that the blade 980 has a rounded / substantially dull distal tip portion 984 that projects outward through the blade access hole 976 in the outer sheath 970. The blade 960 may be substantially the same as the aforementioned blade 960 (having a sharp cutting edge 982 facing in the radial direction). See FIG. 57. In various embodiments, the blade 980 may be made, for example, from titanium, with a gap between the tips of the sharp cutting edges 962 radially opposite the inner wall 971 of the outer sheath 970. It may have a size for an outer sheath 970 to be provided at. In some embodiments, for example, the gap can be approximately 0.0025 cm (0.001 inches). In use, when total rotary motion is applied to the blade 980 in any of the various manners described above and suction is applied to the hollow outer sheath 970, tissue is drawn into it through the window portion 978 and the blade It is trapped between 980 and the inner wall 971 of the outer sheath 970. This action separates tissue long enough to be cut when the device is used in an aqueous environment, for example, as discussed in further detail below. Also in this embodiment, when the blade 980 is ultrasonically powered, the clinician can use the exposed distal tip portion 984 for spot removal of fibrous tissue or for spot coagulation purposes. In some embodiments, the cutting edge 982 may be serrated. In other embodiments, the cutting edge 982 is not serrated.

59 illustrates another non-limiting blade and sheath embodiment. This embodiment utilizes a hollow outer sheath 990 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the aforementioned surgical instruments by any suitable fastening method or connection device. As can be seen in FIG. 58, the outer sheath 990 has a closed rounded or blunt nose portion 992 and a long rectangular shaped window or opening 994. In one embodiment, for example, the rectangular shaped window 994 has a width “W” that is approximately 0.254 cm (0.100 inches) and a length of approximately 0.64 cm (0.25 inches). The sheath 990 can be made from, for example, polyamide or similar material that does not cause heating of the blade 1000 from contact therewith. Window 994 may be defined by sharp edges 995, 997. As can be seen in FIG. 60, the edges 995, 997 can be provided with an angle “B” between them. In some embodiments, angle “B” may be approximately 110 degrees.

These embodiments also utilize a blade 1000 having a waveguide or proximal portion configured to be attached to an ultrasonic horn or motor drive shaft of any of the previously described surgical instruments or others by threaded or other suitable connection device. As can be seen in FIG. 59, the blade 1000 serves to cut tissue aspirated into the window 994 of the outer sheath 990, with a pair of radially opposite sharp cuts formed thereon. It may have a (1002). In various embodiments, the blade 1000 may be made from titanium, for example. The cut portion 1002 of the blade 1000 can have a sharp cut corner 1003 formed thereon. In some embodiments, the cutting corner 1003 may be serrated. In other embodiments, the cutting corner 1003 is not serrated. The cutting portion 1002 acts as a tissue shear between the cutting corner 1003 and the sharp edges 995, 996 of the window opening 994 as the blade 1000 rotates or swings back and forth within the outer sheath 990. It may have a size for the outer sheath 990 to establish a. The blade 1000 may be sized to create a slip fit between them for the outer sheath 990, otherwise the capture of tissue between these two components is prevented. The blade 990 can rotate back and forth (arrow "D") or in a single direction (arrow "E") and, if necessary, can be operated ultrasonically as well as discussed above. See FIG. 59. In use, when total rotational motion is applied to the blade 1000 in any of the various manners described above and suction is applied into the hollow outer sheath 990, tissue “T” is drawn into it through the window 994. And is collected between the blade 1000 and the inner wall 999 of the outer sheath 990. This action separates tissue long enough to be cut when the device is used in an aqueous environment, for example, as discussed in further detail below.

62 illustrates another non-limiting blade and sheath embodiment. This embodiment utilizes a hollow outer sheath 1010 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the aforementioned surgical instruments by any suitable fastening method or connection device. As can be seen in FIG. 61, the outer sheath 1010 can have a closed rounded or blunt nose portion 1012 and a long rectangular shaped window or opening 1014. In one embodiment, for example, window 1014 has a first stamped or recessed edge 1016 and first to define an opening 1019 that may have a width “W” that is approximately 0.254 cm (0.100 inch). It has two stamped or recessed edges 1018. Window 1014 may have a length of approximately 0.25 inch (0.64 cm). Sheath 1010 may be made from, for example, stainless steel.

These embodiments also utilize a blade 1020 having a waveguide or proximal portion configured to be attached to an ultrasonic horn or motor drive shaft of any of the aforementioned surgical instruments or others by threaded or other suitable connection. As can be seen in FIG. 62, the blade 1020 can have a pair of radially opposite sharp cutouts 1022, 1024 formed thereon. The blade 1020 may be made from titanium, for example, and may have a relatively sharp cutting corner 1025 formed on each cut portion 1022, 1024. In some embodiments, the cutting corner 1025 may be serrated. In another embodiment, the cutting corner 1025 is not serrated. The cut portions 1022, 1024 are external to allow for establishing a tissue shear action between the cut edge 1025 and the recessed edge 1016, 1018 as the blade 1020 is rotated or oscillated within the outer sheath 1010. It may have a size for the sheath 1010. Such a configuration forms a relatively small localized area and also reduces the problem of contact between the blade and the outer sheath by promoting the scissoring effect on the tissue. In use, when total rotary motion is applied to the blade 1020 in any of the various manners described above and suction is applied into the hollow outer sheath 1010, tissue is drawn into it through the opening 1019 and the blade It is collected between 1020 and the inner wall 1011 of the outer sheath 1010. This action separates tissue long enough to be cut when the device is used in an aqueous environment, for example, as discussed in further detail below.

64 illustrates another non-limiting blade and sheath embodiment. This embodiment utilizes a hollow outer sheath 1030 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the aforementioned surgical instruments. As can be seen in FIG. 63, the outer sheath 1030 can have a closed rounded or blunt nose portion 1032 and a long rectangular shaped window or opening 1034. Such an embodiment may further comprise a pair of sharp cutting inserts 1036, 1038. The cutting inserts 1036, 1038 may be made from, for example, hardened stainless steel, and may be attached to the hollow sheath 1030 by, for example, welding. Window 1034 may have a width “W” that is approximately 0.254 cm (0.100 inch) and a length of approximately 0.64 cm (0.25 inch). Sheath 1030 may be manufactured from stainless steel, for example.

These embodiments also utilize a blade 1040 having a waveguide or proximal portion configured to be attached to an ultrasonic horn or motor drive shaft of any of the surgical instruments or others described herein by threaded or other suitable connection. As can be seen in FIG. 64, the blade 1040 has a pair of radially opposite cutting portions 1042 formed thereon having a relatively sharp cutting corner 1043. In some embodiments, the cutting corner 1043 may be serrated. In other embodiments, the cutting corner 1043 is not serrated. In various embodiments, the blade 1040 may be made from titanium, for example, and the sharp cutting corner 1043 and the cutting portion (10) may be sharpened as the blade 1020 is rotated or oscillated in the hollow outer sheath 1030. 1042), and may be sized for cutting inserts 1036, 1038 to establish tissue shear action. The outer diameter of the blade 1020 is smaller than the inner diameter of the outer sheath 1030 to provide a gap for the blade 1040 during operation. The only case of contact would be between the cutout 1042 and the inserts 1036, 1038 of the blade 1040 along the window opening 1034 from which tissue is drawn by suction.

66 illustrates another non-limiting blade and sheath embodiment. This embodiment utilizes a hollow outer sheath 1110 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the surgical instruments described above by any suitable fastening method or connection device. As can be seen in FIG. 65, the outer sheath 1110 can have a closed rounded or blunt nose portion 1112 and a long rectangular shaped window or opening 1114. In this embodiment, the lateral edge portions 1116, 1118 of the window 1114 are pressed inwardly or recessed. Window 1014 may have a width “W” that is approximately 0.254 cm (0.10 inches) and a length of approximately 0.64 cm (0.25 inches).

These embodiments also utilize a blade 1120 having a waveguide or proximal portion configured to be attached to an ultrasonic horn or motor drive shaft of any of the surgical instrument embodiments or others described above by screwing or other suitable connecting device. As can be seen in FIG. 66, the blade 1120 has a pair of radially opposite cutting portions 1122 formed thereon having a relatively sharp cutting corner 1023. In some embodiments, the cutting corner 1023 may be serrated. In other embodiments, the cutting corner 1023 is not serrated. In various embodiments, the blade 1020 may be made from titanium, for example, and establishes a tissue shear action between the sharp cutting corner 1023 and the cutting portion 1122 as the blade 1120 is rotated or oscillated. It may have a size for the recessed edge (1116, 1118) to be. Such a configuration defines a larger gap C1 between the cut portion 1122 of the blade 1120 and the inner wall 1111 of the sheath 1110. A gap C2 less than C1 is provided to form a tissue shear action between the lateral edges 1116, 1118 and the cut portion 1122.

67-69 illustrate other non-limiting blade and sheath embodiments. This embodiment utilizes a hollow outer sheath 1210 that can be attached to the nosepiece or ultrasonic transducer assembly of any of the surgical instruments described above. Hollow outer sheath 1210 has a distal nose portion 1212 that includes an upper opening 1214 and a lower opening 1215 that serve to define arcuate lateral side portions 1216 and 1218. Distal nose portion 1212 may further have closed end 1219 extending between lateral side portions 1216 and 1218.

This embodiment further includes a blade 1220 having a waveguide or proximal portion configured to attach to the ultrasonic transducer assembly of any of the surgical instruments described above. The blade 1220 is distal with a cavity 1222 that serves to define a pair of arcuate cutting portions 1224, 1226 extending over the arcuate lateral side portions 1216, 1218 of the hollow sheath 1210. Further has an end portion 1221. One or both of the cut portions 1224, 1226 may have a toothed tooth 1227, or neither may have a toothed tooth. In the embodiment shown in FIG. 67, the cavity 1222 has a cross-sectional shape that is approximately similar to the flat bottom “C”. However, the cavity 1222 may have other cross-sectional shapes. At least one suction passage 1230 may be provided through the blade 1220 as shown. The suction passage may be in communication with a suction source (not shown).

In various embodiments, the blade 1220 may be made from titanium, for example, with the bottom portion 1232 of the blade 1220 downwardly past the lateral sides 1216, 1218 of the nose portion 1212. It may have a size for the distal nose portion 1212 of the hollow sheath 1210 to extend. Similarly, the cutting edges of arcuate side portions 1224 and 1226 extend over lateral sides 1216 and 1218 as shown in FIG. 67. The exposed bottom portion 1232 of the blade 1220 can be used, for example, to solidify tissue, while the cutting edges 1224 and 1226 can be used to cut and separate tissue.

The proximal end 1211 of the hollow sheath 1210 protrudes from the handle housing 1240 as shown in FIG. 70. The handle housing 1240 houses an ultrasonic transducer assembly, a motor, and a slip ring assembly as described above and is coupled to the control system 10. The handle housing 1240 is a selector switch that enables the clinician to switch between the first "ultrasound" mode 1242, the second "shaver" mode 1244, and the third "injection" mode 1246. 1241). The switching mechanism 1241 is in communication with the control system 10 to automatically orient the blade 1220 to the desired rotational orientation. For example, to use the device 1200 in ultrasound mode 1242, the clinician switches the selector switch 1241 to the ultrasound mode position 1242 (shown as operation 1250 in FIG. 71). When in the first ultrasonic configuration 1242, the motor will rotate the blade 1220 to the position shown in FIGS. 67 and 68 (shown as operation 1252 in FIG. 71), and then wait for it at that position Exposed bottom portion 1232 of blade 1220 through hollow sheath 1210 (shown as operation 1254 in FIG. 71). When in that position, the ultrasonic transducer assembly is activated such that the bottom portion 1232 is used to achieve hemostasis (shown as operation 1257 in FIG. 71). In particular, when in ultrasound mode 1242, the clinician may orient the bottom portion 1232 against the bleeding tissue, and then press the tissue sufficient pressure into the exposed portion 1232 of the blade 1220. May be applied (shown as operation 1256 in FIG. 71). The clinician then operates the ultrasonic transducer assembly to achieve hemostasis (shown as operation 1258 in FIG. 71). In an alternative embodiment, the apparatus 1200 may be provided with a series of switches / buttons as described above in communication with the control system such that operation of one switch may initiate rotation. The operation of the other switch may initiate a rotatable oscillation, and the operation of the other switch may cooperate with the control system to rotate the blade to an ultrasonic position and to wait and then activate the ultrasonic transducer assembly, or in another embodiment The ultrasonic transducer assembly in can be operated by another separate switch. All such alternative configurations are within the scope of various non-limiting embodiments and their respective equivalent structures disclosed herein.

72 illustrates the use of device 1200 when in shaver mode 1244. In particular, selector switch 1241 is moved to shaver position 1242 (shown as operation 1260 in FIG. 72). When in that position, the motor continuously rotates the blade 1220 in the hollow outer sheath 1210 (shown as operation 1262 in FIG. 72). In other embodiments, the motor may rotatably swing the blade 1220 back and forth within the outer sheath 1210, or in other embodiments, the selector switch may be moved to another position where rotatable swing is initiated. In either case, the clinician may then contact the rotating or oscillating blades 1220 to cause the tissue to be shaved and discharged through the suction passage 1230 (shown as operation 1264 in FIG. 72).

73 illustrates the use of the device 1200 when in the injection mode 1246. In particular, the selector switch 1241 is moved to the injection position 1246 (shown as operation 1270 in FIG. 73). When in that position, the blade 1220 is held in a standby position (shown as operation 1272 in FIG. 73). The clinician can then orient the blade to the desired position and then inject the desired drug (shown as operation 1274 in FIG. 73). One form of drug that may be infused may include, for example, cell-producing drugs sold under the trade name "Carticel". However, other drugs and drugs can be used. The infusion operation causes the drug passage 1284 extending through the blade 1220 to be exposed through the outer sheath 1210 to allow the drug 1220 to be advantageously applied to the adjacent site, thereby allowing the blade 1220 to enter the outer sheath 1210. It can be achieved by orienting to a predetermined position. The drug can then be injected by operating a pump 1280 in communication with the source of drug 1282. See FIG. 70. In various embodiments, the device 1200 may have an infusion trigger 1249, which causes the pump 1280 to inject drugs out through the passage 1284 (FIG. 68) by actuation of the infusion trigger 1249. Communicate with pump 1280. In alternative embodiments, the drug may be manually injected by a syringe, for example, into a port (not shown) in communication with the drug passage 1284 in the blade 1220.

74-77 illustrate another non-limiting surgical instrument embodiment 1300. Device 1300 may include any one of the handpiece devices 300, 400, 500 described above. For example, the device 1300 may include a handpiece 300 that includes the differences mentioned below. Handpiece 300 includes a blade 200 having a waveguide or proximal portion coupled to an ultrasonic transducer assembly that, when actuated, applies ultrasonic motion to blade 200. Blade 200 may also be rotated by a motor device housed within handpiece 300 as described above. Blade 200 may extend through inner sheath 1320 protruding from handpiece 300. The blade 200 is selectively vibrated and rotated freely in the inner sheath 1320. One or more seal members 1322 may be provided between blade 200 and inner sheath 1320 to prevent fluid and tissue from entering the area between inner sheath 1320 and blade 200. The seal member 1322 may be made from, for example, silicone silicone.

The device 1300 can further include an outer sheath 1330 movably received in the inner sheath 1320. The outer sheath 1330 can be sized for the inner sheath 1320 to allow the suction tube 1350 to extend between a portion of the inner sheath 1320 and a portion of the outer sheath 1330. Suction tube 1350 may be in communication with a suction source, shown generally at 1352. See FIG. 74. As can be seen in FIGS. 74-77, the outer sheath 1330 can include a swing arm portion 1332 protruding distal from the distal end portion 1331 of the outer sheath 1330. . Swing arm 1332 may be relatively straight (FIG. 75), or may have a slightly curved distal end 1334 (FIG. 76). As can be seen in FIG. 76, the distal end 1334 can have a sharp cutting surface 1336 thereon. As can also be seen in FIGS. 74-76, in some embodiments, the blade 200 may have a curved blade tip 1360 having a pair of lateral cutting edges 1362 formed thereon. have. In other embodiments, the blade tip 1360 may be straight. In some embodiments, the blade 200 can be rotated in the various ways discussed above. In other embodiments, the blade 200 may not rotate. In such embodiments, for example, the clinician may choose not to operate a motor for rotating the blade, or the handpiece may include a handpiece that does not include a motor for rotating the blade.

In use, swing arm portion 1332 may cover a portion of distal end 1360 of blade 200. In one mode of use, the outer sheath 1330 is retained in a position where the swing arm portion 1332 covers the back of the blade 200 as shown in FIG. 74. Such a configuration leaves the curved blade tip 1360 exposed. When in such a position, for example, the curved blade tip 1360 can be used to incise tissue, such as meniscus. In a second mode of operation, swing arm portion 1332 is moving.

In the embodiment shown in FIGS. 74-77, the suction tube 1350 is used to suck loose tissue towards the blade tip 1360 and also to remove small sections of dissected tissue during cutting. In another embodiment, suction may occur in an annular space between the sheaths 1320 and 1330. In another embodiment, the blade 200 may have a suction path (not shown) extending therethrough that is in final communication with the suction source as described above. Such a suction path would be easiest to exit the blade 200 at the node at the proximal end. In another embodiment, no inhalation is used.

In some embodiments, swing arm portion 1332 may be permanently retained in a position against blade 200. In another embodiment, a slippery or low friction pad (not shown) may be mounted to swing arm portion 1332 such that the pad contacts the blade 200. In other embodiments, a clearance of 0.002 cm to 0.010 cm (0.002 cm to 0.010 cm) may be provided between the swing arm portion 1332 and the blade 200. In another embodiment, the swing arm portion 1332 extends around the length of the curved portion of the blade 200 such that the entire blade 200 is covered from the back.

The various non-limiting embodiments described above can be effectively used with a variety of other surgical applications, and are particularly suitable for cutting and solidifying tissue in the aqueous environment of arthroscopic surgery. However, in such applications, when fluid passes between the blade or waveguide and the inner sheath, the fluid may enter the housing and damage the internal components. Various sealing devices are known for use with ultrasonically powered surgical instruments. For example, US Pat. No. 5,935,144 and US Pat. No. 5,944,737, each of which is incorporated by reference in their entirety, are each referred to as ultrasound surgery in the traditional (ie, non-aqueous) environment of laparoscopic surgery and laparotomy. Various sealing devices are disclosed for use with the instrument. However, various non-limiting embodiments discussed below utilize an improved sealing device that may be better suited for use in an aqueous environment.

More specifically, and referring to FIG. 78, an ultrasonic device 1400 is shown that includes a housing 1402 rotatably supporting an ultrasonic transducer assembly 1404 therein. For example, the ultrasonic transducer assembly 1404 may be rotatably supported in the housing 1402 by a series of bearings (not shown). An ultrasonic horn 1406 can be coupled to the ultrasonic transducer assembly 1404, and the ultrasonic tool 1410 is typically attached thereto by conventional means, which can include a threaded device. As used herein, the term “ultrasound tool” may include any one of the blade and cutting member embodiments described herein. The portion of the ultrasonic tool 1410 coupled to the ultrasonic horn 1406 may be referred to as waveguide portion 1412. Waveguide 1412 may comprise an integral portion of ultrasonic tool 1410 or may include separate components attached thereto, for example by screwing connections. In the embodiment shown in FIG. 78, the ultrasonic tool 1410 extends through the hollow outer sheath 1420. The distal end of the outer sheath 1420 and the ultrasonic tool 1410 can be configured in any of a variety of blade and sheath configurations and others described herein.

As can also be seen in FIG. 78, a proximal shaft 1430 is attached to the ultrasonic transducer assembly 1404. Attached to the proximal shaft 1430 is a driven gear 1432, which is engaged with the drive gear 1434 coupled to the output shaft 1434 of the motor 1440. Ultrasonic electrical signals and motor control signals may be supplied from the control system 10 through the slip ring assembly 1450 of the type and configuration described above. The device 1400 can further include the various control button configurations described above, such that the device can be used in an ultrasound mode, a non-ultrasound mode (eg, a rotating shaving mode), and a combination of such modes. Unlike the various instruments described above, the motor 1440 is not coaxially aligned with the ultrasonic transducer assembly.

79 illustrates a non-limiting embodiment of a seal assembly 1470 that can be used between the waveguide or proximal portion 1412 of the ultrasonic tool 1410 and the outer sheath 1420. Seal 1470 includes an annular member, which may be made from silicon or other material, for example Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node "N". . The seal 1470 extends axially in the opposite axial directions in the opposite axial directions beyond the first annular seal portion 1472 and the first annular seal portion 1472 formed at the node “N” onto the waveguide 1412. It can have two axial seal portions 1474, 1476 separated by 1478. The groove 1478 may enable the two axial seal portions 1474, 1476 to bend somewhat relative to each other in sealing contact with the outer sheath 1420. The narrower first annular seal portion 1472 can avoid excessive heat accumulation while providing a wider contact area where the seal 1470 contacts the outer sheath 1420.

80 illustrates a non-limiting embodiment of a seal 1480 that can be used between the waveguide or proximal portion 1412 of the ultrasonic tool 1410 and the outer sheath 1420. Seal 1480 includes an annular member, which may be made from silicon or other material, such as, for example, Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node "N". . Seal 1480 may be arranged to abut an inwardly extending annular abutment ring 1490 formed on outer sheath 1420. Seal 1480 is positioned distal to abutment ring 1490. When fluid pressure is accumulated in the distal end of outer sheath 1420, seal 1480 is pressed into abutment ring 1490 to increase the strength of the seal. The outer sheath 1420 can be made, for example, from stainless steel.

FIG. 81 illustrates a non-limiting embodiment of a seal 1500 that can be used between the waveguide portion 1412 of the blade 1410 and the outer sheath 1420. Seal 1500 includes an annular member, which may be made from silicon or other material, for example Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node " N ". . The seal 1480 may be arranged to be received in an annular groove 1423 provided in the outer sheath 1420. The outer sheath 1420 can be made, for example, from stainless steel.

82 illustrates a non-limiting embodiment of a seal 1510 that can be used between the waveguide or proximal portion 1412 of the ultrasonic tool 1410 and the outer sheath 1420. Seal 1510 includes an annular member, which may be made from silicon or other material, for example Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node "N". . Seal 1510 extends in the axial direction in opposing directions beyond inner rim portion 1512, and inner portion 1512 that is molded onto waveguide 1412 at node " N " It can have two axial seal portions 1514, 1516 separated by. Axial portions 1514 and 1516 are sized to extend into grooves 1520 provided in outer sheath 1420. As can be seen in FIG. 82, the groove 1520 has an inwardly projecting ring 1522 that has a size extending into the groove 1518 in the seal 1510. In the illustrated embodiment, the ring 1522 has an inclined lamp 1524 formed thereon, which allows the seal 1510 to slide in place after assembly during assembly. The outer sheath 1420 can be manufactured, for example, from Ultem®.

83 and 84 illustrate a non-limiting embodiment of a seal 1530 that can be used between the waveguide or proximal portion 1412 of the ultrasonic tool 1410 and the outer sheath 1420. Seal 1530 includes an annular member, which may be made from silicon or other material, for example Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node "N". . The seal 1530 may have a groove 1532 therein as shown in FIG. 83. The outer sheath 1420 is then crimped to compress the seal 1530 as shown in FIG. 84. The outer sheath 1420 can be crimped evenly over the circumference or can be crimped in discrete locations. For example, four evenly spaced (eg, at 90 degree intervals) crimps can be used. In such embodiments, the outer sheath 1420 can be made from, for example, stainless steel.

85 shows a portion of an outer sheath 1540 having a proximal axial portion 1542 and a distal axial section 1544 configured to be interconnected together by, for example, welding, interference fitting, screwing, or snapping together. To show. As can be seen in FIG. 85, the distal axial section 1544 is an annular seal 1550 overmolded or otherwise sealingly installed in the waveguide or proximal portion 1412 of the ultrasonic tool 1410 at node “N”. It has a groove portion 1546 that is sized to engage a portion of the. Thus, when attached together, proximal axial section 1542 and distal axial section 1544 serve to capture and compress a portion of seal 1550 therebetween. In alternative embodiments, the groove portion 1546 may be provided in the proximal axial section 1542, or each section 1542, 1544 may have a groove segment that cooperates to receive the annular seal 1550 therein. Can have on.

FIG. 86 shows a portion of the outer sheath, indicated generally at 1560 and consisting of two lateral halves 1562, 1564. Each lateral half 1562, 1564 has a semi-annular groove segment 1566 formed therein. See FIG. 87. Semi-annular groove segment 1566 is an annulus that is overmolded or otherwise attached to waveguide or proximal portion 1412 when lateral halves 1562 and 1564 are joined together to form hollow outer sheath 1560. An annular groove 1568 is formed that is sized to receive the seal 1570. By creating a two-piece outer sheath 1560, the seal 1570 is much larger than the outer sheath 1560 that would normally have if the waveguide 1412 had to be pressed against the outer sheath 1560 during the assembly process. May have interference with The two outer sheath halves 1562, 1564 may be joined together by welding, snap fit, or other suitable method. Thus, seal 1570 may first be installed on waveguide 1412. Thereafter, two halves 1562 and 1564 may be joined around waveguide 1412 such that seal 1570 is trapped in groove 1568. Thereafter, halves 1562 and 1564 are fastened together in that position.

88 illustrates a non-limiting embodiment of a seal 1580 that can be used between waveguide portion 1412 and an outer sheath 1420 of an ultrasonic tool. Seal 1580 includes an annular member that can be made from silicon or other material, such as, for example, Ultem®, and is overmolded or otherwise sealed to waveguide or proximal portion 1412 at node " N ". Is attached. Seal 1580 may be held in place by proximal ring 1590 and distal ring 1592. Proximal ring 1590 may include an integral portion of outer sheath 1420 or may include separate components pressed into or otherwise attached to outer sheath 1420. Distal ring 1592 may be glued, interference fit, or otherwise attached to outer sheath 1420. Distal ring 1592 may provide compression to seal 1580 at installation. This will increase the force between seal 1580 and waveguide 1412, further reducing fluid movement through seal 1580. Rings 1590 and 1592 may include annular rings or rings with no splits therein. In addition, as can be seen in FIG. 88, rings 1590 and 1592 may be sized for waveguide 1412 such that a certain amount of gap “C” is provided between them.

89 illustrates a non-limiting embodiment of a seal 1600 that can be used between the waveguide or proximal portion 1412 of the ultrasonic tool 1410 and the outer sheath 1420. Seal 1600 includes an annular member, which may be made from silicon or other material, for example Ultem®, and is overmolded or otherwise sealingly attached to waveguide 1412 at node " N ". . The seal 1600 may have an outer diameter that is greater than the inner diameter of the outer sheath 1420. Seal 1600 may also have a proximal side 1602 and distal side 1604. When assembled, the outer portion of the proximal side 1602 of the seal 1600 is in sealing contact with the inner wall 1421 of the outer sheath 1420. Thus, when fluid pressure “P” accumulates on the distal side of seal 1600, seal 1600 is further pressurized to make sealing contact with outer sheath 1420, thereby waveguide 1412 and outer sheath 1420. To create a better seal.

90 illustrates a non-limiting embodiment of a seal 1610 that can be used between the waveguide or proximal portion 1412 of the blade and the outer sheath 1420. Seal 1610 includes an annular member that may be made from silicon or other material, such as, for example, Ultem®, and is molded or otherwise attached to outer sheath 1420 as shown. In such an embodiment, an annular groove 1620 may be provided in the waveguide 1412 to receive a portion of the seal 1610 therein. In an alternative embodiment, no groove is provided. The seals shown in FIGS. 79-82 are external sheaths instead of waveguides or proximal portions of cutting blades or tools as illustrated without departing from the spirit and scope of the various non-limiting embodiments and their respective equivalents disclosed herein. It will also be appreciated that it can be similarly attached to In addition, it will also be appreciated that the various seal embodiments described herein can be used effectively with any of the surgical instrument embodiments described above. That is, the various non-limiting seal devices and their respective equivalent structures disclosed herein can be effectively used to achieve a seal between an ultrasonic blade or waveguide and a corresponding inner sheath. In such embodiments that utilize an inner sheath and an outer sheath but do not apply suction therebetween, the various non-limiting seal devices and their respective equivalents disclosed herein also provide substantially liquid seal between the inner sheath and the outer sheath. Can be effectively used to achieve. In another non-limiting embodiment, the seal can be used between the ultrasonic blade and the outer sheath, in which case the ultrasonic blade is not involved in the overall rotational movement with respect to the outer sheath. In such embodiments, the seal can be firmly attached to the ultrasonic blade and the outer sheath. In another non-limiting embodiment, the ultrasonic blade can oscillate in the outer sheath. For example, the ultrasonic blade can oscillate through a 90 degree arc (45 degrees on each side of the central axis). In such embodiments, the seal may be firmly attached to the outer sheath and the ultrasonic blade, for example by adhesive, crimping, or the like. The seal material may include an elastic rubber material or the like that will accommodate the torsion of the seal over a range of ± 45 degrees. In such an embodiment, the elongation experienced by the seal may help return the blade to its neutral position of zero degrees (aligned to the central axis).

The various embodiments described above utilize a rotating blade that serves to shear out tissue between the cutting edge formed on the blade and the edge of the surrounding outer sheath. While such a configuration is very effective for cutting most tissues, it can be difficult to cut effectively because tough tissues, such as tendon tissue, may tend to "milk" between the blade and the outer sheath. . Such problems are similar to those encountered when scissors are used to cut through tough materials, such as leather, for example. In summary, the scissors blades are separated and the material is not cut. This phenomenon is shown schematically in FIGS. 91A-91D. As can be seen in these figures, two cutting blades 1700 are used to cut tough tissue “T”. As the blades 1700 move inward toward the tissue "T", the tissue "T" moves between the blades 1700 and causes them to separate.

In the various blade and sheath embodiments disclosed herein, it may be advantageous to minimize the size of the gap between the cutting portion of the outer sheath and the cutting edge (s) of the blade. For example, it may be desirable to maintain the size of the gap between the cut portion of the outer sheath and the cut edge (s) of the blade within the range of 0.0025 cm (0.001 ") to 0.013 cm (0.005"). In another non-limiting embodiment, one cut edge or portion is harder than the other cut portion. For example, the cutting edge (s) on the blade may be harder than the cutting portion of the outer sheath, or vice versa. The motor can then be operated with or without ultrasound to achieve a near zero gap between the cutting edges / portions. In addition to or instead of such an approach, other embodiments may employ a structure that deflects at least the distal portion of the blade in an “off center” arrangement in the outer sheath while further facilitating the rotation of the blade therein. More specifically, and referring to FIGS. 92 and 93, a blade 200 of the type and structure described above is shown extending through the outer sheath assembly 3000. In the illustrated embodiment, the outer sheath assembly 3000 may be configured in any manner described above to selectively apply ultrasonic motion to the blade 200 as well as selectively apply total rotational motion thereto. 3001).

In the embodiment shown in FIG. 93, the blade 200 extends axially through an inner sheath 3020 mounted within a portion of the instrument housing 3010. The outer sheath assembly 3000 is attached to the instrument housing 3010 and has a distal tip portion 3002 having a window or opening 3004 therein. As discussed above, the window 3004 enables tissue to be sucked into the tip cavity 3006 formed in the distal tip portion 3002. Suction may be applied to tip cavity 3006 through suction port 3007 in distal tip portion 3002 of outer sheath assembly 3000 in communication with suction source 244. In these embodiments, the blade 200 is somewhat flexible and may be made from titanium, for example. Further, the waveguide portion or proximal portion of the blade 200 extends through a bushing 3030 mounted in the inner sheath 3020 at the position of node "N". In various embodiments, the inner sheath 3020 may be made from a material that is substantially rigid and resistant to bending. For example, the inner sheath 3020 can be made from an Ultem or similar material. Bushing 3030 may be manufactured, for example, from Ultem® and may be held non-rotatable in inner sheath 3020 by, for example, stainless steel.

As can be seen in FIGS. 92A and 93, the waveguide or proximal portion 701 of the blade 200 extends through the aperture 3032 of the bushing 3030. The centerline CL-CL of the bushing hole 3032 is offset (ie not coaxial) from the central axis A-A defined by the outer sheath 3000. Bushing hole 3032 has a size relative to the proximal portion 701 of the blade 200 that allows the proximal portion 701 to rotate freely therein, while also cutting tissue distal end 705 of the blade 200. ) Deflects the distal end portion 700 of the blade 200 away from the central axis AA of the outer sheath 3000 so that it is held in rotatable contact with the cutting edge 3005 defined by the window opening 3004. do. In some embodiments, for example, blade 200 may be deflected off center at a distance that may be as large as 0.030 cm (0.076 cm). Tissue cutting distal end 705 of blade 200 deflects in such a manner. The distal end 705 may cut tough tissue that would otherwise cause the cutting edge 706 on the distal end 705 to move away from the cutting edge 3005 of the window opening 3004. Resist the power of time.

94 and 95 show that the proximal portion 701 of the blade 200 can be made, for example, of silicone silicone or Ultem® and retained in the inner sheath 3020 by, for example, a sliding fit. Illustrates another embodiment extending coaxially through a bushing 3040 that may be. As in the above embodiment, bushing 3040 may be located at node "N" along the waveguide or proximal portion of blade 200. However, in this embodiment, the distal portion 711 (ie, the portion of the blade 200 extending distal from the bushing 3040) of the blade 200 into the cutting edge 3005 of the window opening 3004. Slightly bent to deflect tissue cutting distal end 705. For example, the distal portion 711 of the blade 200 may be bent off center by approximately 0.076 cm (0.030 inch) (distance OS in FIG. 95). This configuration can cause the tissue cutting distal end 705 of the blade 200 to move away from the cutting edge 3005 of the window opening 3004, otherwise the cutting edge 706 of the blade 200 will be moved. Resist the strength of cutting tough tissue.

96 and 97 illustrate another non-limiting outer sheath 3040 and blade 200 embodiment. In this embodiment, distal outer sheath tip 3050 is used. Distal outer sheath tip 3050 may be made from a metal, such as, for example, stainless steel, and may have a proximal bearing portion 3052 extending into open distal end 3062 of outer sheath 3060. The outer sheath 3060 can be made from stainless steel, for example, and can be attached to the distal outer sheath tip 3050 by fasteners, adhesives, and the like. The proximal end 3062 of the outer sheath 3060 is attached to a portion of the instrument housing as described above. The instrument may include many of the various instrument embodiments described above in detail that supply the blade 200 with ultrasonic motion as well as overall rotational motion.

The waveguide or proximal portion 701 of the blade 200 may be attached to an ultrasonic horn (not shown) and may extend through the inner sheath 3070 in the various manners described above. The proximal portion 701 of the blade 200 may be rotatably supported in the inner sheath 3070 by a bushing 3040 as described above. Distal portion 711 of blade 200 extends rotatably through lumen 3054 in distal outer sheath tip 3050. See FIG. 97. A window 3056 is formed at the distal outer sheath tip 3050 to expose the tissue cutting distal end 705 of the blade 200. As in the various embodiments described above, the window 3056 has at least one cutting edge 3057 that interacts with the rotating tissue cutting distal end 705 of the blade 200 to cut tissue sucked into the window 3056. ) Can be defined. In this embodiment, the outer diameter “OD” of the tissue cutting distal end portion 705 of the blade 200 at the point where the distal end 705 of the blade 200 protrudes distal into the window opening 3056 is defined as the lumen ( 3054) is larger than the inner diameter "ID". In some embodiments, for example, the lumen inner diameter "ID" may be approximately 0.356 cm (0.140 ") and the blade" OD "may be approximately 0.381 cm (0.150"). Such a configuration causes interference between the tissue cutting distal end 705 of the blade 200 and the distal outer sheath tip 3050. In such a configuration, the distal portion 711 of the blade 200 is essentially a cantilever beam that causes the tissue cutting distal end 705 of the blade 200 to be pushed downward by the distal outer sheath tip 3050 (FIG. 97). It includes.

In the embodiment shown in FIGS. 92-97, it would be desirable to provide a sized gap between the distal end 3058 of the distal outer sheath tip 3050 and the curved tip portion 702 of the blade 200. Can be. This gap "C" is illustrated in FIG. 97. Such gaps allow unobstructed ultrasonic movement of the blade 200. However, it may be desirable to minimize such gap "C" to reduce suction loss around the curved tip portion 702 which may interfere with the device's ability to cut tissue.

In addition, suction should be applied within the distal outer sheath tip 3050 from a source of inhalation (not shown) to facilitate suction of tissue into the window opening 3056. In this embodiment, for example, a suction path 3080 is provided in the distal outer sheath tip 3050 as shown in FIGS. 97 and 98. Seal 3090 is journaled to distal portion 711 of blade 200 to establish a liquid tight seal at the point where distal portion 711 of blade 200 exits inner sheath 3070. See FIG. 97. Also in this embodiment, the distal end 3062 of the inner sheath 2070 extends into an opening 3055 in the bearing portion 3052 of the distal outer sheath tip 3050 to provide relatively firm support thereto. As can be seen in FIG. 98, the suction path 3080 forms a discontinuity in the inner sheath support surface 3057 defined by the opening 3055. FIG. 99 shows an alternative distal outer sheath tip 3050 ′ where the intake path 3080 ′ does not extend into an opening 3055 ′ supporting the distal end 3062 of the inner sheath 3070.

Various ultrasonic surgical instruments utilizing external sheaths and rotatable cutting member devices also face the problem of external sheath and blade deformation due to heat and high contact forces between these two components. Deformation of the distal tip portion of the outer sheath can be reduced by changing the tip material to metal, but this can result in an undesirable effect of damaging the blades through galling, which ultimately results in broken blades and extremely limited May result in blade life. Such sheath tip blade wear damage can occur due to metal to metal contact between the blade and the sheath tip. This condition can be exacerbated when cutting tough tissues such as tendons. As discussed above, such tough tissue may deflect the cutting edges away from each other and may force the opposing cutting edges or faces of the blade to contact the sheath tip, resulting in wear and tear.

The various non-limiting embodiments and their respective equivalents described herein can utilize thin friction reducing materials on the inner wall of the tip cavity formed in the distal tip portion of the outer sheath, or in alternative embodiments low friction or friction Reduction pads may be attached in the tip cavity to protect the blades. One exemplary embodiment is shown in FIGS. 100 and 101. As can be seen in these figures, the outer sheath 900 'described above has a friction reducing polymer coating or pad 3100 therein. In various embodiments, the distal tip portion 902 'of the sheath 900' may be made from a metal, such as stainless steel, and the friction reducing material or pad 3100 may be, for example, polyimide, carbon-filled poly, Mead, Teflon®, Teflon-ceramic and the like. In these embodiments where pads are used, the pads may be attached in tip portion 902 ', for example, by an adhesive or dovetail joint device. The pad 3100 is preferably configured to match the corresponding geometry of the blade. For example, as shown in FIG. 101, the blade 3110, which may be substantially similar to the blade 200 described above, is distal having a central portion 3114 that separates the two cut faces 3116, 3118. Has an end portion 3112. Cutting faces 3116 and 3118 have an arcuate shape and have cutting edges 3120 formed on their respective edges. In that embodiment, the polymer pad 3100 also has a similarly arcuate shaped top surface 3101. The advantage of this concept is that it maintains a hard metal cutting edge (eg stainless steel) that is advantageous for cutting tough tissue. It also protects the wide cut surfaces 3116 and 3118 of the blade 200 when the pad 3100 is made of softer material that can otherwise support the force applied to the blade. Additionally or alternatively, the inner wall 903 ′ of the tip portion 902 ′ may be coated with a friction reducing coating 3130 of the type described above. The coating 3130 may include a separate component that is held in place through the adhesive, or may include a deposition coating that directly adheres to the inner surface 903 'of the tip portion 902'. For example, Teflon® material may be applied to the portion of the interior wall 903 'via deposition. Portions of the tip 902 'where no coating is required may be masked using known masking techniques prior to exposing the tip 902' to the deposition process.

FIG. 102 illustrates a tissue cutting blade end 3112 ′ that may be coated with a relatively hard, low friction material to increase surface hardness and reduce friction. In particular, as can be seen in the figure, at least a portion of the cut surfaces 3116 ', 3118' are coated with a coating material 3130. In some embodiments, for example, the coating material may include coating materials such as titanium nitride, diamond-like coating materials, chromium nitride, and Graphite iC ™. Blade 3060 'may be used with an external sheath tip made from metal (eg, stainless steel) to avoid blade wear and ultimate blade failure. In alternative embodiments, the entire distal tissue cut end of the blade may be coated with coating material 3130.

The devices disclosed herein may be designed to be disposed of after one use, or they may be designed to be used multiple times. In either case, however, the device may be reinstated for reuse after at least one use. Restoration may include any combination of disassembly of the device, subsequent cleaning or replacement of the particular fragment, and subsequent reassembly. In particular, the device may be disassembled and any number of specific pieces or parts of the device may be selectively replaced or removed in any combination. Upon cleaning and / or replacement of a particular part, the device may be reassembled for subsequent use by the surgical team at the restoration facility or just prior to the surgical procedure. Those skilled in the art will appreciate that reinstatement of the device may utilize various techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting reverted devices are all within the scope of this application.

Preferably, the various embodiments described herein will be processed prior to surgery. First, a new or used instrument is obtained and cleaned if necessary. The instrument may then be disinfected. In one disinfection technique, the instrument is placed in a closed and sealed container, such as a plastic or Tyvek bag. The vessel and instrument are then placed in a radiation region that can penetrate the vessel, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterilized container. The sealed container keeps the instrument disinfected until the container is opened at the medical facility. Disinfection can also be accomplished by any of a number of ways known to those skilled in the art, including beta or gamma radiation, ethylene oxide, and / or steam.

In various embodiments, the ultrasound surgical instrument may be supplied to the surgeon with a waveguide and / or end actuator already operatively coupled with the transducer of the surgical instrument. In at least one such embodiment, the surgeon or other clinician can remove the ultrasonic surgical instrument from the sterile package, connect the ultrasonic instrument to the generator as described above, and use the ultrasonic instrument during the surgical procedure. Such a system may eliminate the need for a surgeon or other clinician to assemble a waveguide and / or end actuator in an ultrasound surgical instrument. After using the ultrasound surgical instrument, the surgeon or other clinician may place the ultrasound instrument in a sealable package and the package may be shipped to a disinfection facility. In the disinfection facility, the ultrasonic instrument can be sterilized and any spent parts can be discarded and replaced, while any reusable parts can be disinfected and used once again. Thereafter, the ultrasonic instrument may be reassembled, tested, placed in a disinfection package, and / or disinfected after being placed in the package. Once sterilized, the regenerated ultrasound surgical instrument can be used once again.

Although various embodiments have been described herein, many modifications and variations can be made to these embodiments. For example, different types of end actuators can be used. Also, while materials are disclosed for certain components, other materials may be used. The foregoing description and following claims are intended to cover all such modifications and variations.

All of the above-mentioned U.S. patents and U.S. patent applications and published U.S. patent applications are hereby incorporated by reference in their entirety, although the materials contained herein are current definitions, representations, or otherwise described in this disclosure. Included only to the extent that it does not conflict with the initiation data. As such and to the extent necessary, the disclosure as explicitly set forth herein replaces any conflicting material incorporated by reference herein. Any material or portion thereof that is referred to as incorporated herein by reference but which conflicts with the present definitions, expressions, or other disclosure materials described herein is to the extent that no conflict exists between the included materials and the current disclosure data. Will be included.

Claims (18)

housing;
An ultrasonic transducer assembly rotatably supported in the housing and in communication with a source of ultrasonic electrical signals;
A motor in said housing in communication with a source of motor drive signals, said motor coupled to said ultrasonic transducer assembly for applying rotational motion to said ultrasonic transducer assembly;
A horn coupled to the ultrasonic transducer assembly;
A hollow outer sheath having a distal tip portion coupled to the housing and having at least one cutting edge formed thereon; And
A blade coupled to the horn and having a tissue cutting distal end, such that the tissue cutting distal end is deflected in a cut engagement with the at least one cutting edge on the distal tip portion of the hollow outer sheath. And said blade rotatably supported within an outer sheath. The ultrasonic surgical instrument of claim 1 wherein the proximal portion of the blade is rotatably supported in an inner sheath supported in the housing. The ultrasound surgical instrument of claim 2, wherein the proximal portion of the blade is rotatably supported in a bushing supported in the inner sheath. 4. The ultrasound surgical method of claim 3, wherein the bushing is coaxially aligned on a central axis defined by the outer sheath and the blades extend through holes in the bushing that are not coaxially aligned on the central axis. Instrument. The ultrasound surgical instrument of claim 2 wherein the distal portion protrudes distal from the inner sheath and the distal portion of the blade is not aligned coaxially with the proximal portion of the blade. The surgical instrument of claim 1, wherein the blade extends rotatably through a lumen in the hollow outer sheath, and the distal tissue cut end of the blade has an outer diameter greater than the inner diameter of the lumen. . The ultrasound surgical instrument of claim 1 wherein the distal tissue cutting end of the blade has a curved blade tip portion rotatably received within a tip cavity formed in the distal tip portion of the hollow outer sheath. 8. The ultrasound surgical instrument of claim 7, further comprising a gap of a predetermined size between the curved blade tip portion and the distal tip portion of the hollow sheath. The suction port of claim 1, further comprising: a suction port in the outer sheath, for applying suction to the outer sheath from a source of suction coupled to the suction port. Included, ultrasonic surgical instruments. housing;
An ultrasonic transducer assembly rotatably supported within the housing and in communication with a source of ultrasonic electrical signals;
A motor in said housing in communication with a source of motor drive signals, said motor coupled to said ultrasonic transducer assembly for applying rotational motion to said ultrasonic transducer assembly;
A horn coupled to the ultrasonic transducer assembly;
A hollow outer sheath coupled to the housing and having a distal tip portion defining a tip cavity therein;
A blade having a tissue cutting distal end coupled to the horn, the blade having a tissue cutting distal end portion rotatably supported in the outer sheath and rotatably supported in the tip cavity; And
And a friction reducing material in the tip cavity. The ultrasonic surgical instrument of claim 10, wherein the friction reducing material is applied to an inner wall portion of the tip cavity. The instrument of claim 10, wherein the friction reducing material comprises a friction reducing pad mounted within the tip cavity. The surgical instrument of claim 12, wherein the friction reducing pad has a surface having a surface that matches the geometry of a portion of the tissue cutting distal end of the blade member. The ultrasound surgical pad of claim 12, wherein the friction reducing pad is made from a material selected from the group consisting of polyimide material, Teflon material, carbon-filled polyimide material, and Teflon-ceramic material. Instrument. The ultrasound surgical instrument of claim 10, further comprising another friction reducing material on at least a portion of the tissue cutting distal end of the blade. housing;
An ultrasonic transducer assembly rotatably supported within the housing and in communication with a source of ultrasonic electrical signals;
A motor in said housing in communication with a source of motor drive signals, said motor coupled to said ultrasonic transducer assembly for applying rotational motion to said ultrasonic transducer assembly;
A horn coupled to the ultrasonic transducer assembly;
A hollow outer sheath coupled to the housing and having a distal tip portion defining a tip cavity therein;
A blade coupled to the horn and rotatably supported in the outer sheath, the blade having a tissue cutting distal end portion rotatably supported in the tip cavity; And
And a low friction material on at least a portion of the tissue cutting distal end of the blade. 17. The ultrasound surgical instrument of claim 16, wherein the low friction material is selected from the group of hard low friction materials consisting of titanium nitride, diamond coating material, chromium nitride and graphite-iC. The method of claim 16, wherein the tissue cutting distal end of the blade comprises a pair of arcuate cut faces separated by a central portion, each arcuate cut face having at least one cut edge formed thereon, And the low friction material is applied to at least a portion of each of the arcuate cutting surfaces.

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